NPIMap

Organization Active NPI

Green Acres Baptist Church

  • Professional Counselor
  • Tyler, TX
National Provider Identifier
1437838612
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
GREEN ACRES BAPTIST CHURCH
Practice address
5755 Eagles Nest Blvd Ste 4
Tyler, TX 75703-6236
Phone
(903) 533-1817
NPI assigned
Jul 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Jaime Dawn Cornelius, LPC-ANPI 1417711292
Title
Clinic Director
Phone
(903) 533-1817

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

5755 Eagles Nest Blvd Ste 4
Tyler, TX 75703-6236

Mailing address

1607 Troup Hwy
Tyler, TX 75701-5799
Phone (903) 533-1817

National Provider Directory

National Provider Directory
Tax ID family
Green Acres Baptist Church2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5755 Eagles Nest Blvd
Ste 4
Tyler, TX 75703
Phone (903) 533-1817

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1437838612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 TROUP HWY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015799",
            "telephone_number": "903-533-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5755 EAGLES NEST BLVD STE 4",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757036236",
            "telephone_number": "903-533-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN ACRES BAPTIST CHURCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "CORNELIUS",
        "authorized_official_first_name": "JAIME",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "903-533-1817",
        "authorized_official_credential": "LPC-A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.