Green Acres Baptist Church

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

GREEN ACRES BAPTIST CHURCH

Practice address

5755 Eagles Nest Blvd Ste 4
Tyler, TX 75703-6236

Phone

(903) 533-1817

NPI assigned

Jun 15, 2023

Organization subpart

No

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

Authorized official

Name

Jaime Dawn CorneliusNPI 1417711292

Title

Clinic Director

Phone

(903) 533-1817

Specialties & licenses 1

Addresses

Tax ID family

Green Acres Baptist Church2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Green Acres Baptist Church

  • Professional Counselor
  • Tyler, TX
  • NPI 1437838612
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaime Dawn Cornelius

  • Professional Counselor
  • Tyler, TX
  • NPI 1417711292
  NPD Authorized official
• Faith Abraham, LPC

  • Professional Counselor
  • Tyler, TX
  • NPI 1508789876
  NPD (past)

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

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1376228619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 TROUP HWY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015799",
            "telephone_number": "903-533-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5755 EAGLES NEST BLVD STE 4",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757036236",
            "telephone_number": "903-533-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN ACRES BAPTIST CHURCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "CORNELIUS",
        "authorized_official_first_name": "JAIME",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "903-533-1817"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Gray
• Grayce Nutrition and Wellness, LLC
• Lillie Grayson
• Greater Foundation Foot Clinics East Texas, PLLC
• Richard David Greczanik, D.O.
• Green Acres Baptist Church
• Bradley Andrew Green, PHD
• Cossette Alina Green, DO
• Darrelland Green, LPC-A
• Jacqueline Green

• Counselor in Tyler, TX
• Providers in Tyler, TX by specialty
• Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.