Individual provider Active NPI

Jill Elyse Rogers, LCMHC-S

  • Mental Health Counselor
  • Clemmons, NC
National Provider Identifier
1437568334
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
A11031 Issued in NC
Practice address
2235 Lewisville Clemmons Rd Ste a
Clemmons, NC 27012-9342
Phone
(336) 722-7266
Fax
(336) 201-0538
NPI assigned
Aug 5, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X A11031 NC Primary

Addresses

Primary practice location

2235 Lewisville Clemmons Rd Ste a
Clemmons, NC 27012-9342

Mailing address

713 S Marshall St
Winston Salem, NC 27101-5808
Phone (336) 722-7266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A11031NCMDMental Health Counselor
11031NCMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
A Grounded Path Wellness, PLLC Current Accepting new patients
Wellmood PLLC PastSince Jan 1, 2024 Accepting new patients
Complete Care Partners LLC PastSince May 14, 2023 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1437568334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 S MARSHALL ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271015808",
            "telephone_number": "336-722-7266",
            "fax_number": "336-201-0538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 LEWISVILLE CLEMMONS RD STE A",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129342",
            "telephone_number": "336-722-7266",
            "fax_number": "336-201-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "JILL",
        "middle_name": "ELYSE",
        "credential": "LCMHC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-05",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A11031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

Verify at the official NPI Registry.