Tanja Supon-Clause, MA LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC010837 Issued in GA

Practice address

109 Cotton Bluff CT
Guyton, GA 31312-7540

Phone

(912) 433-5099

NPI assigned

Mar 18, 2019

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

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tanja.supon-clause.1@30520.direct.athenahealth.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.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  GA, Professional

  Medicare reassignment Care Compare group NPD
• Jennings & Associates

  • Clinical Psychologist
  • Savannah, GA
  • NPI 1891467007
  NPD (past)

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1639638703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 COTTON BLUFF CT",
            "city": "GUYTON",
            "state": "GA",
            "postal_code": "313127540",
            "telephone_number": "912-433-5099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 COTTON BLUFF CT",
            "city": "GUYTON",
            "state": "GA",
            "postal_code": "313127540",
            "telephone_number": "912-433-5099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPON-CLAUSE",
        "first_name": "TANJA",
        "credential": "MA LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-18",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC010837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison Jeaneen Smith
• Soriano Medical Services Inc
• Dino Vincent Soriano Sr., RN MSN HSA FNP-C
• Lynn Sparling, BCBA
• Harley Strickland
• Ashley Meghan Swartz
• Sydnee Hope Taylor
• Kristen Bowers Turner, OTR/L
• Sandra Vanorman
• Enrique Velazquez

• All providers in Guyton, GA
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.