Active NPI
Ellen Super Thomas, LPC
- Professional Counselor
- Mableton, GA
National Provider Identifier
1417656323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC011541
- Practice address
- 783 Creek Glen Rd
Mableton, GA 30126-2797 - Phone
- (404) 840-8234
- NPI assigned
- Feb 28, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC011541 | GA | Primary |
Addresses
Primary practice location
783 Creek Glen Rd
Mableton, GA 30126-2797
Mailing address
783 Creek Glen Rd
Mableton, GA 30126-2797
Phone (404) 840-8234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 19, 2024 through Mar 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC011541 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677542400000",
"number": "1417656323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "783 CREEK GLEN RD",
"city": "MABLETON",
"state": "GA",
"postal_code": "301262797",
"telephone_number": "404-840-8234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "783 CREEK GLEN RD",
"city": "MABLETON",
"state": "GA",
"postal_code": "301262797",
"telephone_number": "404-840-8234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "ELLEN",
"middle_name": "SUPER",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-28",
"last_updated": "2023-02-28",
"certification_date": "2023-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC011541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mableton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.