Individual provider Active NPI

Jennifer Scott Sudderth, LPC

  • Professional Counselor
  • Athens, GA
National Provider Identifier
1245688241
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC012819 Issued in GA
Practice address
745 S Milledge Ave Ste a
Athens, GA 30605-1291
Phone
(770) 389-8100
NPI assigned
May 31, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 012819 GA
Professional Counselor 101YP2500X LPC012819 GA Primary
Professional Counselor 101YP2500X 7371 SC

Addresses

Primary practice location

745 S Milledge Ave Ste a
Athens, GA 30605-1291

Mailing address

1737 Hewell Rd NW
Dewy Rose, GA 30634-2956
Phone (706) 371-4020

Other practice location 1

1737 Hewell Rd NW
Dewy Rose, GA 30634-2956
Phone (706) 371-4020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20241212003909 GA Practitioner - Mental Health Counselor 8325574338 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

745 S Millage Ave
Suite a
Athens, GA 30605
Phone (470) 795-7681

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
012819GAMDProfessional Counselor
LPC012819GAMDProfessional Counselor
7371SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC Professional CurrentSince Aug 1, 2024 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1245688241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1737 HEWELL RD NW",
            "city": "DEWY ROSE",
            "state": "GA",
            "postal_code": "306342956",
            "telephone_number": "706-371-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 S MILLEDGE AVE STE A",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306051291",
            "telephone_number": "770-389-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1737 Hewell Rd NW",
            "address_purpose": "LOCATION",
            "city": "Dewy Rose",
            "state": "GA",
            "postal_code": "306342956",
            "country_code": "US",
            "telephone_number": "706-371-4020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUDDERTH",
        "first_name": "JENNIFER",
        "middle_name": "SCOTT",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-31",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "012819",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC012819",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "7371",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

Verify at the official NPI Registry.