Envision Behavioral Health PLLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2016-01870 Issued in NC

Legal business name

ENVISION BEHAVIORAL HEALTH PLLC

Practice address

2554 Lewisville Clemmons Rd Ste 207
Clemmons, NC 27012-9752

Phone

(304) 617-4337

Fax

(339) 207-0143

NPI assigned

May 25, 2018

Organization subpart

No

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

Authorized official

Name

Jessica Cipoletti Derreberry, MDNPI 1093943599

Title

Managing Member

Phone

(304) 617-4337

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Cipoletti Derreberry, M.D.

  • Psychiatry Physician
  • Winston Salem, NC
  • NPI 1093943599

  Psychiatry

  NPD Authorized official
• Todd Michael Derreberry, M.D.

  • Psychiatry Physician
  • Clemmons, NC
  • NPI 1295962066

  Psychiatry

  NPD

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

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1689165508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 STADIUM OAKS DR STE B",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD STE 207",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129752",
            "telephone_number": "304-617-4337",
            "fax_number": "339-207-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION BEHAVIORAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-25",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "DERREBERRY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "CIPOLETTI",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "304-617-4337",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2016-01870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elms at Tanglewood, LLC
• Nicholas Charles Embroz
• Janie Emory, MS. CCC-SLP
• Uzma Enayatulla-Nasir, M.D.
• Parks Engstrom
• Martha Lumngwegang Eseh, NP
• Myshalae Jamerson Euring, PHD, LCMHC, CRC, NCC
• Robert S Evans, M.S., CCC-SLP
• Esther Fakayode, NURSE PRACTIONER
• Lauren Elizabeth Fennell, CNM

• All providers in Clemmons, NC
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.