NPIMap

Organization Active NPI

Counseling Services of Lagrange, Inc.

  • Clinical Psychologist
  • Lagrange, GA
National Provider Identifier
1790197804
Registry record updated Jun 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY003497 Issued in GA
Legal business name
COUNSELING SERVICES OF LAGRANGE, INC.
Practice address
610 Ridley Ave
Lagrange, GA 30240-2236
Phone
(706) 884-5050
Fax
(706) 884-5056
NPI assigned
May 22, 2014
Last updated
Jun 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2015

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

Authorized official

Name
Shannon Keith Dunlap, PHDNPI 1194950857
Title
Owner/Director
Phone
(706) 884-5050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY003497 GA Primary

Addresses

Primary practice location

610 Ridley Ave
Lagrange, GA 30240-2236

Mailing address

610 Ridley Ave
Lagrange, GA 30240-2236
Phone (706) 884-5050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140609001622 GA Part B Supplier - Clinic/Group Practice 0446474639 Receives reassigned benefits from 1 practitioner
Practice locations: Lagrange, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1790197804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402236",
            "telephone_number": "706-884-5050",
            "fax_number": "706-884-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402236",
            "telephone_number": "706-884-5050",
            "fax_number": "706-884-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNSELING SERVICES OF LAGRANGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-22",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "DUNLAP",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "706-884-5050",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.