Active NPI
Jennifer Cummings Tillery, LPC, NCC
- Professional Counselor
- Kennesaw, GA
National Provider Identifier
1700268265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC008457
- Practice address
- 5150 Stilesboro Rd NW
Suite 430
Kennesaw, GA 30152-7744 - Phone
- (404) 433-6153
- NPI assigned
- Jun 22, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC008457 | GA | Primary |
Addresses
Primary practice location
5150 Stilesboro Rd NW
Suite 430
Kennesaw, GA 30152-7744
Mailing address
434 Shepard Dr SW
Marietta, GA 30064-1560
Phone (404) 433-6153
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC008457 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434931200000",
"number": "1700268265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "434 SHEPARD DR SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300641560",
"telephone_number": "404-433-6153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5150 STILESBORO RD NW",
"address_2": "SUITE 430",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301527744",
"telephone_number": "404-433-6153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLERY",
"first_name": "JENNIFER",
"middle_name": "CUMMINGS",
"name_prefix": "Mrs.",
"credential": "LPC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-22",
"last_updated": "2015-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC008457",
"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 Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.