Jenny Matlack, MA, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC014952 Issued in PA

Practice address

1200 Atwater Dr Ste 130
Malvern, PA 19355-8782

Phone

(610) 646-1851

Fax

(484) 355-5181

NPI assigned

Nov 24, 2014

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

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Ellie Main Line LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Malvern, PA
  • NPI 1528752037
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  PA

  Medicare reassignment NPD

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

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1376940015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 ATWATER DR STE 130",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193558782",
            "telephone_number": "610-646-1851",
            "fax_number": "484-355-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 ATWATER DR STE 130",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193558782",
            "telephone_number": "610-646-1851",
            "fax_number": "484-355-5181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATLACK",
        "first_name": "JENNY",
        "credential": "MA, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-24",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC014952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn M Marple Gise, LCSW
• Isabel Martinez, RN
• Arpna Gupta Masuraha, PT
• Maternal Child Consortium Inc
• Dana McAllister Matkovic, MPT
• Maureen Vita LLC
• Maximus Home Care Inc
• Haley McCarthy
• Kelly McClure, PHD
• Alexandra Jean McCormick, PA-C

• Professional Counselor in Malvern, PA
• Providers in Malvern, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.