South Table Wellness

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

SOUTH TABLE WELLNESS

Practice address

2550 Youngfield St # 4
Lakewood, CO 80215-1033

Phone

(720) 324-7939

NPI assigned

Apr 20, 2022

Organization subpart

No

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

Authorized official

Name

Jaclyn Ripperger-Harrell, LCSWNPI 1760027411

Title

Managing Member

Phone

(720) 324-7939

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

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

• Jaclyn Ripperger-Harrell, LCSW

  • Clinical Social Worker
  • Lakewood, CO
  • NPI 1760027411
  Medicare reassignment NPD Authorized official
• Danielle Leigh Powell, BS

  • Case Manager/Care Coordinator
  • Spartanburg, SC
  • NPI 1962603845
  NPD

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706918400000",
    "number": "1386387975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2903 LOOKOUT VIEW DR",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804012521",
            "telephone_number": "720-324-7939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 YOUNGFIELD ST # 4",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802151033",
            "telephone_number": "720-324-7939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TABLE WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-20",
        "last_updated": "2024-02-03",
        "certification_date": "2024-02-03",
        "status": "A",
        "authorized_official_last_name": "RIPPERGER-HARRELL",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "720-324-7939",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anastasia Soroka
• Timothy L Sorrells, MD
• Jonathan Soto
• Sound Body Chiropractic and Wellness LLC
• Source Counseling and Contracting LLC
• Lizbeth Saray South
• Kaleigh Southern
• Sowash Optometry Group PC
• Sowash Optometry Group PC
• Sowash Optometry Group PC

• Adult Mental Health Clinic/Center in Lakewood, CO
• Providers in Lakewood, CO by specialty
• Adult Mental Health Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.