Individual provider Active NPI

Jennie Brogan, LPC

  • Professional Counselor
  • Radford, VA
National Provider Identifier
1841945979
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701011225 Issued in VA
Practice address
401 W Main St
Radford, VA 24141-1588
Phone
(540) 838-8000
Fax
(540) 904-0051
NPI assigned
Feb 17, 2022
Last updated
Feb 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X 0701011225 VA Primary

Addresses

Primary practice location

401 W Main St
Radford, VA 24141-1588

Mailing address

700 University City Blvd
Blacksburg, VA 24060-2706
Phone (540) 961-8388

Other names 1

  • Jennie Brogan Kelly Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240219003646 VA Practitioner - Mental Health Counselor 3375987266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

106 Southpark Dr
Suite C
Blacksburg, VA 24060-6809
Phone (855) 284-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0701011225VAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC Mental Health CurrentSince Jan 16, 2024 Accepting new patients

Locations

106 Southpark Dr
Ste C
Blacksburg, VA 24060
Phone (540) 361-6270

5310 Markel Rd
Ste 102
Richmond, VA 23230
Phone (804) 312-5498

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1645056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1841945979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 UNIVERSITY CITY BLVD",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240602706",
            "telephone_number": "540-961-8388",
            "fax_number": "540-322-1847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W MAIN ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411588",
            "telephone_number": "540-838-8000",
            "fax_number": "540-904-0051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROGAN",
        "first_name": "JENNIE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-17",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701011225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIE",
            "last_name": "KELLY",
            "middle_name": "BROGAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Radford, VA

Sources for this page

Verify at the official NPI Registry.