Active NPI
Brooklyn Lane
- Mental Health Counselor
- Blakely, GA
National Provider Identifier
1629833868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- APC009522
- Practice address
- 763 Jesse Johnson Dr
Blakely, GA 39823-3224 - Phone
- (229) 724-2050
- NPI assigned
- Feb 16, 2024
- Last updated
- Feb 16, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | APC009522 | GA | Primary |
Addresses
Primary practice location
763 Jesse Johnson Dr
Blakely, GA 39823-3224
Mailing address
PO Box 1988
Albany, GA 31702-1988
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2252 Clarence Lane Rd
Iron City, GA 39859-3219
PO Box
Suite 1988
Albany, GA 31702
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APC009522 | GA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708041600000",
"number": "1629833868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1988",
"city": "ALBANY",
"state": "GA",
"postal_code": "317021988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "763 JESSE JOHNSON DR",
"city": "BLAKELY",
"state": "GA",
"postal_code": "398233224",
"telephone_number": "229-724-2050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "BROOKLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-16",
"last_updated": "2024-02-16",
"certification_date": "2024-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "APC009522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blakely, GA
- J.H. Harveys Co. (Harveys Supermarket Pharmacy #2380)
- Josephine Johnson
- Sydney Thomas Johnson
- Valerie Rebecca Jones, RPH
- Allison Josey, ARNP
- Chandra Levatte
- Rachel Lewis
- Lifebrite Hospital Group of Early LLC
- Lifebrite Hospital Group of Early LLC (Early Emergency Care)
- Lifebrite Hospital Group of Early LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.