A Beautiful Mind Counseling Services

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

A BEAUTIFUL MIND COUNSELING SERVICES

Practice address

1100 Clay St
Vicksburg, MS 39183-2912

Phone

(601) 831-7325

NPI assigned

Apr 10, 2024

Organization subpart

No

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

Authorized official

Name

Joycelyn Lashae Green, LCSWNPI 1649879461

Title

License Clinical Social Worker

Phone

(601) 831-7325

Specialties & licenses 1

Addresses

Other names 1

• A Beautiful Mind Counseling Services Former legal business name

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

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

• Joycelyn Green

  • Clinical Social Worker
  • Vicksburg, MS
  • NPI 1649879461

  Mental Health, MS

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1712707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1386497162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 NORTH DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391809304",
            "telephone_number": "601-831-7325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CLAY ST",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391832912",
            "telephone_number": "601-831-7325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BEAUTIFUL MIND COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JOYCELYN",
        "authorized_official_middle_name": "LASHAE",
        "authorized_official_title_or_position": "LICENSE CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "601-831-7325",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A Beautiful Mind Counseling Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.