Individual provider Active NPI

Ruth Tedla

  • Professional Counselor
  • Fairfax, VA
National Provider Identifier
1255701488
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701004430 Issued in VA
Practice address
8221 Willow Oaks Corporate Dr
Lower Level
Fairfax, VA 22031-4512
Phone
(703) 383-8402
NPI assigned
Sep 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0701004430 VA Primary

Addresses

Primary practice location

8221 Willow Oaks Corporate Dr
Lower Level
Fairfax, VA 22031-4512

Mailing address

8221 Willow Oaks Corporate Dr
Lower Level
Fairfax, VA 22031-4512
Phone (703) 383-8402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20240102001690 DC Practitioner - Mental Health Counselor 0749630895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Director of Finance-County of Fairfax VAGroup PAC ID 9739136847, 176 clinicians

Practice addresses (Care Compare)

12011 Goverment Ctr Pkwy
Suite 836
Fairfax, VA 22035-1100
Phone (703) 324-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0701004430VAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfax County, Virginia CurrentSince Jan 1, 2024 Accepting new patients

Locations

12011 Government Center Pkwy
Ste 836
Fairfax, VA 22035
Phone (703) 324-7017

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031
Phone (703) 289-7599

8221 Willow Oaks Corporate Dr
Lowr
Fairfax, VA 22031
Phone (703) 383-8402

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": "1443571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1255701488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8221 WILLOW OAKS CORPORATE DR",
            "address_2": "LOWER LEVEL",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314512",
            "telephone_number": "703-383-8402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8221 WILLOW OAKS CORPORATE DR",
            "address_2": "LOWER LEVEL",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314512",
            "telephone_number": "703-383-8402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDLA",
        "first_name": "RUTH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-30",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701004430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.