Kimberly Jill Osborne, EDS, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC006170 Issued in GA

Practice address

1269 Parker Rd SE
Conyers, GA 30094-5957

Phone

(404) 234-0546

Fax

(770) 761-9070

NPI assigned

Nov 3, 2010

Last updated

Aug 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Jill Osborne, LPC, LLC

  • Professional Counselor
  • Conyers, GA
  • NPI 1952835704
  Medicare reassignment NPD Authorized official
• Inge Luechinger Family Therapy PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Clayton, GA
  • NPI 1770686024
  NPD

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

{
    "created_epoch": "1288742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1629378955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1269 PARKER RD SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945957",
            "telephone_number": "404-234-0546",
            "fax_number": "770-761-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1269 PARKER RD SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945957",
            "telephone_number": "404-234-0546",
            "fax_number": "770-761-9070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1944 Brannan Rd",
            "address_purpose": "LOCATION",
            "city": "McDonough",
            "state": "GA",
            "postal_code": "302534310",
            "country_code": "US",
            "telephone_number": "404-234-0546",
            "fax_number": "678-289-6981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OSBORNE",
        "first_name": "KIMBERLY",
        "middle_name": "JILL",
        "name_prefix": "Mrs.",
        "credential": "EDS, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-03",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC006170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003112500A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003188998A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003112503A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.therasoft.com",
            "affiliation": "N",
            "endpointDescription": "www.therasoft.com",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PDF",
            "address_1": "1269 Parker Rd SE",
            "city": "Conyers",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300945957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.