Active NPI
Jerry Dean Worsham Jr., LPC
- Mental Health Counselor
- Oxford, MS
National Provider Identifier
1336339498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 795
- Practice address
- 510 Azalea Dr
Oxford, MS 38655-8114 - Phone
- (662) 513-3411
- NPI assigned
- Jul 25, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 795 | MS | Primary |
Addresses
Primary practice location
510 Azalea Dr
Oxford, MS 38655-8114
Mailing address
510 Azalea Dr
Oxford, MS 38655-8114
Phone (662) 513-3411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Mar 19, 2025 through Mar 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 795 | MS | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185321600000",
"number": "1336339498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 AZALEA DR",
"city": "OXFORD",
"state": "MS",
"postal_code": "386558114",
"telephone_number": "662-513-3411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 AZALEA DR",
"city": "OXFORD",
"state": "MS",
"postal_code": "386558114",
"telephone_number": "662-513-3411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORSHAM",
"first_name": "JERRY",
"middle_name": "DEAN",
"name_suffix": "Jr.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-25",
"last_updated": "2007-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MS",
"license": "795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oxford, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.