Ellise Latryce Garmon

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5478 Issued in LA

Practice address

1006 Highland Ave
Shreveport, LA 71101-4103

Phone

(318) 678-7500

NPI assigned

Aug 19, 2021

Last updated

Aug 19, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brentwood Acquisition-Shreveport IncGroup PAC ID 1951379312, shared by 2 NPIs, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jenkins Counseling Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Shreveport, LA
  • NPI 1831556216
  Medicare reassignment NPD

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1568138469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 HIGHLAND AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 HIGHLAND AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014103",
            "telephone_number": "318-678-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARMON",
        "first_name": "ELLISE",
        "middle_name": "LATRYCE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "LA",
            "license": "5478",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "5478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Martin Gardner, R.N
• Lawrence Gale Gardner, M.D.
• Marissa Gardner
• Shante Gardner
• Mason Tauer Garfield, PA-C
• Garner Counseling Services LLC
• Quintraia Garner, LPC
• Roland Deshane Garner Jr.
• Ashley D'Anna Garrett, NP
• Emily Garrett

• Professional Counselor in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Professional Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.