Jaquelynn Elizabeth Cornelius, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

8684 Issued in ID

Practice address

2596 N Stokesberry PL
Meridian, ID 83646-6114

Phone

(208) 918-1636

NPI assigned

Mar 24, 2022

Last updated

Mar 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Willow Emotional and Relational Health LLCGroup PAC ID 9739609165, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Willow Emotional & Relational Health, LLC

  • Marriage & Family Therapist
  • Baldwin City, KS
  • NPI 1003492729
  Medicare reassignment Care Compare group NPD
• Thomason Counseling Services

  • Counselor
  • Meridian, ID
  • NPI 1154086924
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1184374241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2596 N STOKESBERRY PL",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466114",
            "telephone_number": "208-918-1636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2596 N STOKESBERRY PL",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466114",
            "telephone_number": "208-918-1636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELIUS",
        "first_name": "JAQUELYNN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-24",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "8684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8684",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elsira Coram
• Gina Celine Cordero, LAT, ATC
• Ann Marie Corey, N.P.
• Andrea Elizabeth Corliss, WHNP-BC
• Denise Cornejo-Vucovich, M.D.
• Cornerstone Health PLLC
• Cornerstone Supported Living (Cornerstone Transport)
• Elizabeth Corrao
• Dianira Renee Cortez, LPC
• Luis Javier Cortez II, LPC

• Professional Counselor in Meridian, ID
• Providers in Meridian, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.