Tim Fennell, PHD

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC009594 Issued in GA

Practice address

3990 Clairmont Rd
Chamblee, GA 30341-4938

Phone

(407) 595-0146

Fax

(877) 260-8720

NPI assigned

Nov 21, 2011

Last updated

Nov 12, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fenn Systems Inc.

  • Counselor
  • Oviedo, FL
  • NPI 1063943942
  Authorized official Same address or phone
• Atlantis Therapy Services Inc.

  • Occupational Therapist
  • Winter Springs, FL
  • NPI 1629317672
  NPD (past)
• Fenn Systems Inc.

  • Social Worker
  • Winter Park, FL
  • NPI 1275863235
  NPD (past)
• Lakemont Clininc Inc

  • Family Medicine Physician
  • Winter Park, FL
  • NPI 1871706093
  NPD (past)

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

{
    "created_epoch": "1321833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573516800000",
    "number": "1356618201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5703 RED BUG LAKE RD # 518",
            "city": "WINTER SPRINGS",
            "state": "FL",
            "postal_code": "327084969",
            "telephone_number": "407-595-7006",
            "fax_number": "877-260-8720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 CLAIRMONT RD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "303414938",
            "telephone_number": "407-595-0146",
            "fax_number": "877-260-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNELL",
        "first_name": "TIM",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-21",
        "last_updated": "2019-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC009594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Eshleman, M. ED., BCBA
• Sarah Annalise Estrada
• Family First Medical Center, LLC
• Jiong Fan, MD
• Whitney Feinberg, MD
• Marlon David Anthony Foote, DDS
• Ashley Ford, M.S. CCC-SLP
• Esther W. Fortingo
• Cheng Gao, DMD
• Luis A Garcia-Lugo, DC

• Professional Counselor in Chamblee, GA
• Providers in Chamblee, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.