Individual provider Active NPI

Jessica Taylor Andreychuk

  • Professional Counselor
  • Phoenix, AZ
National Provider Identifier
1336868652
Registry record updated Nov 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC-24083 Issued in AZ
Practice address
3420 E Shea Blvd Ste 200
Phoenix, AZ 85028-3348
Phone
(480) 500-9284
NPI assigned
Aug 22, 2022
Last updated
Nov 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2025

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 LPC-24083 AZ Primary

Addresses

Primary practice location

3420 E Shea Blvd Ste 200
Phoenix, AZ 85028-3348

Mailing address

3420 E Shea Blvd Ste 200
Phoenix, AZ 85028-3348

Other names 1

  • Jesse Taylor Andreychuk Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jesse@rootedserenityco.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LPC-24083AZMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lifeline Professional Counseling Services, Inc Past Accepting new patients
Lifeline Professional Counseling Services, Inc Past Accepting new patients
Lifeline Professional Counseling Services, Inc Past Accepting new patients
Lifeline Professional Counseling Services, Inc Counselor Past Accepting new patients
Lifeline Professional Counseling Services, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jesse@rootedserenityco.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762473600000",
    "number": "1336868652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 E SHEA BLVD STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 E SHEA BLVD STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283348",
            "telephone_number": "480-500-9284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDREYCHUK",
        "first_name": "JESSICA",
        "middle_name": "TAYLOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-22",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-24083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jesse@rootedserenityco.com",
            "affiliation": "N",
            "endpointDescription": "practice email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3420 E Shea Blvd Ste 200",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850283348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSE",
            "last_name": "ANDREYCHUK",
            "middle_name": "TAYLOR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2025; 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.