Jennifer Petell, PH.D IN CLINICAL PSY

Primary specialty

PsychologistTaxonomy code 103T00000X

License

641185 Issued in MS

Practice address

5908 Getwell Rd
Southaven, MS 38672-7317

Phone

(901) 536-4646

Fax

(662) 536-4443

NPI assigned

Jul 10, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MS, TN2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Primary Care Group, LLCGroup PAC ID 0941480131, 108 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Primary Care Group LLC

  • Family Medicine Physician
  • Memphis, TN
  • NPI 1093016651

  MS

  Medicare reassignment Care Compare group NPD
• Desoto Family Counseling Center PLLC

  • Community/Behavioral Health Agency
  • Southaven, MS
  • NPI 1912214792

  Mental Health

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Methodist Healthcare - Olive Branch Hospital

  • General Acute Care Hospital
  • Olive Branch, MS
  • NPI 1912341439
  Care Compare affiliation

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

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1710505268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 330",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5908 GETWELL RD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386727317",
            "telephone_number": "901-536-4646",
            "fax_number": "662-536-4443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6570 Summer Oaks Cv",
            "address_purpose": "LOCATION",
            "city": "Bartlett",
            "state": "TN",
            "postal_code": "381342857",
            "country_code": "US",
            "telephone_number": "901-536-4646",
            "fax_number": "662-536-4443",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5480 Goodman Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Olive Branch",
            "state": "MS",
            "postal_code": "386547902",
            "country_code": "US",
            "telephone_number": "662-874-6507",
            "fax_number": "662-932-8197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETELL",
        "first_name": "JENNIFER",
        "credential": "PH.D IN CLINICAL PSY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-10",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MS",
            "license": "641185",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "4107",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Pearson
• Leslie B Pearson, NP
• Turner Donaldson Peckham
• Airreal Pegues, MS
• Madison Grace Pena, PTA
• Calleen Patricia Petersen, LMSW
• John S Petrides
• Tracey F Petrides, M.D.
• Blanche Foshee' Petty, APRN
• Pharmcare USA of Memphis, Inc (Pharm Care Inc)

• Psychologist in Southaven, MS
• Providers in Southaven, MS by specialty
• Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; 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.