Individual provider Active NPI

Clarissa Yvonne Lesueur

  • Behavior Technician
  • Kennesaw, GA
National Provider Identifier
1629550694
Registry record updated Jul 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
3330 Chastain Meadows Pkwy NW Ste 200
Kennesaw, GA 30144-5881
Phone
(510) 422-6311
NPI assigned
Sep 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary

Addresses

Primary practice location

3330 Chastain Meadows Pkwy NW Ste 200
Kennesaw, GA 30144-5881

Mailing address

1615 Cobb Pkwy N Apt 2007
Marietta, GA 30062-2476
Phone (843) 254-6087

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659139200000",
    "number": "1629550694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 COBB PKWY N APT 2007",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622476",
            "telephone_number": "843-254-6087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 CHASTAIN MEADOWS PKWY NW STE 200",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301445881",
            "telephone_number": "510-422-6311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESUEUR",
        "first_name": "CLARISSA",
        "middle_name": "YVONNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-05",
        "last_updated": "2022-07-30",
        "certification_date": "2022-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2022; 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.