Jessica Erin Vallor, M.S. ART THERAPY

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

APC006481 Issued in GA

Practice address

255 Village Pkwy NE
Marietta, GA 30067-4158

Phone

(770) 726-9589

NPI assigned

Jan 6, 2017

Reactivated

Mar 29, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Jessica Erin Staley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1483660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553904000000",
    "number": "1215473897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 SUMMER TERRACE LN",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303422663",
            "telephone_number": "941-321-5874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 VILLAGE PKWY NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300674158",
            "telephone_number": "770-726-9589"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1820 Memorial Cir",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370434539",
            "country_code": "US",
            "telephone_number": "931-920-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALLOR",
        "first_name": "JESSICA",
        "middle_name": "ERIN",
        "name_prefix": "Mrs.",
        "credential": "M.S. ART THERAPY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-06",
        "last_updated": "2019-03-30",
        "deactivation_date": "2019-03-07",
        "reactivation_date": "2019-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "APC006481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "STALEY",
            "middle_name": "ERIN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Marietta, GA
• Providers in Marietta, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.