Ita L Jervis

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

73488 Issued in TX

Practice address

2323 Timber Shadows Dr Ste B
Kingwood, TX 77339-2028

Phone

(832) 233-3086

Fax

(832) 415-3050

NPI assigned

May 14, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Kbccms, LLC

  • Professional Counselor
  • Oxford, MS
  • NPI 1841899978
  NPD

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

{
    "created_epoch": "1620950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1346814449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5857",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773255857",
            "telephone_number": "832-233-3086",
            "fax_number": "832-415-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 TIMBER SHADOWS DR STE B",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773392028",
            "telephone_number": "832-233-3086",
            "fax_number": "832-415-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERVIS",
        "first_name": "ITA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-14",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "73488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC",
            "identifier": "73488",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claudel Duclos Jean-Pierre, M.D.
• Chester Jefferson, LPC
• Natalie Shea Jennings
• Jenny Jacobs Counseling, PLLC
• Jenro Holdings LLC
• Jhartsaw Therapy PLLC
• Pavan Jhaveri, M.D.
• Shuchita Jhaveri, MD
• Yuhang Jia, M.D.
• Dylan Jiang

• Professional Counselor in Kingwood, TX
• Providers in Kingwood, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.