NPIMap

Organization Active NPI

SRM Counseling & Therapeutic Services, LLC

  • Professional Counselor
  • Alpharetta, GA
National Provider Identifier
1396114880
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
005648 Issued in GA
Legal business name
SRM COUNSELING & THERAPEUTIC SERVICES, LLC
Practice address
320 Maxwell Rd
Suite 300
Alpharetta, GA 30009-2070
Phone
(678) 371-4580
Fax
(770) 995-1959
NPI assigned
Sep 15, 2015
Last updated
Jun 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

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

Authorized official

Name
Mrs. Jeanette A. McClellan, LPC
Title
Licensed Professional Counselor
Phone
(678) 371-4580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 005648 GA Primary

Addresses

Primary practice location

320 Maxwell Rd
Suite 300
Alpharetta, GA 30009-2070

Mailing address

320 Maxwell Rd
Suite 300
Alpharetta, GA 30009-2070
Phone (678) 371-4580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160311000278 GA Part B Supplier - Clinic/Group Practice 0840596268 Receives reassigned benefits from 3 practitioners
Practice locations: Alpharetta, GA

National Provider Directory

National Provider Directory

Locations

320 Maxwell Rd
Ste 300
Alpharetta, GA 30009
Phone (404) 942-8229

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1396114880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 MAXWELL RD",
            "address_2": "SUITE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300092070",
            "telephone_number": "678-371-4580",
            "fax_number": "770-995-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 MAXWELL RD",
            "address_2": "SUITE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300092070",
            "telephone_number": "678-371-4580",
            "fax_number": "770-995-1959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRM COUNSELING & THERAPEUTIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "MCCLELLAN",
        "authorized_official_first_name": "JEANETTE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "LICENSED PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "678-371-4580",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "005648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; 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.