NPIMap

Organization Active NPI

Nutritional & Psychological Wellness, LLC

  • Mental Health Counselor
  • Greenville, SC
National Provider Identifier
1821766007
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
NUTRITIONAL & PSYCHOLOGICAL WELLNESS, LLC
Practice address
107 E Park Ave
Greenville, SC 29601-1631
Phone
(864) 735-0842
NPI assigned
Sep 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Ms. Audrey Suzanne Connell, MA, LPCNPI 1376895821
Title
Owner, Licensed Professional Counse
Phone
(864) 735-0842

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
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

107 E Park Ave
Greenville, SC 29601-1631

Mailing address

69 Sikes Cir
Mauldin, SC 29662-2590
Phone (716) 628-8250

Other identifiers 3

IdentifierTypeStateIssuer
1376895821MedicaidSC
1376895821OtherSCCIGNA
1376895821OtherSCBLUE CROSS BLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://www.simplepractice.com/welcome-back/ Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1821766007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 SIKES CIR",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622590",
            "telephone_number": "716-628-8250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E PARK AVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296011631",
            "telephone_number": "864-735-0842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRITIONAL & PSYCHOLOGICAL WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "CONNELL",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "OWNER, LICENSED PROFESSIONAL COUNSE",
        "authorized_official_telephone_number": "864-735-0842",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376895821",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1376895821",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1376895821",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.simplepractice.com/welcome-back/",
            "affiliation": "N",
            "endpointDescription": "https://www.simplepractice.com/welcome-back/",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "HIPPAA compliant Fax and Portal",
            "address_1": "107 E Park Ave",
            "city": "Greenville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296011631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.