Glenn Anthony Niles Jr., LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC009918 Issued in GA

Practice address

4039 Gateway Blvd
Grovetown, GA 30813-3389

Phone

(706) 498-9570

Fax

(678) 369-5762

NPI assigned

Oct 26, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: georgiabehavioralhealthprofessionals.glennniles@124220.advancedmd-direct.com

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.

• Personal Recovery Network LLC

  • Psychiatry Physician
  • Stockbridge, GA
  • NPI 1881990869

  Professional

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1508976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1477065720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4039 GATEWAY BLVD",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308133389",
            "telephone_number": "706-498-9570",
            "fax_number": "678-369-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4039 GATEWAY BLVD",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308133389",
            "telephone_number": "706-498-9570",
            "fax_number": "678-369-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILES",
        "first_name": "GLENN",
        "middle_name": "ANTHONY",
        "name_suffix": "Jr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-26",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC009918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Jane Regl Mullins, PT, DPT
• Hanna Assefa Negash, MD
• Nephrology Centers of America, LLC
• Charles Nessmith
• Sarah Eloise New, NP
• April Noriega, MS
• Shareika Norman
• Wesley Norton, PT, DPT
• Cindy Marie O'Neal, M.A., CCC-SLP
• Charity S Odum, LPC016028

• Professional Counselor in Grovetown, GA
• Providers in Grovetown, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.