Jenise Trannell Clark, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

715 Bradley Dr
Fayetteville, GA 30214-2030

Phone

(770) 358-5252

NPI assigned

May 4, 2018

Last updated

Mar 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• McIntosh Trail Community Service Board

  • Community/Behavioral Health Agency
  • Griffin, GA
  • NPI 1336317270
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA

  Medicare reassignment NPD
• McIntosh Trail Community Service Board

  • Community/Behavioral Health Agency
  • Griffin, GA
  • NPI 1386708212
  NPD
• McIntosh Trail Community Service Board

  • Community/Behavioral Health Agency
  • Jackson, GA
  • NPI 1265610406
  NPD (past)
• McIntosh Trail Community Service Board

  dba Fayette Co Counseling Center

  • Community/Behavioral Health Agency
  • Fayetteville, GA
  • NPI 1689852840
  NPD (past)

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1851880926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3777 WALDROP LN",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300346786",
            "telephone_number": "404-274-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 BRADLEY DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302142030",
            "telephone_number": "770-358-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENISE",
        "middle_name": "TRANNELL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-04",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dae'Yanna Cisero, RBT
• City EMS of Georgia LLC
• Aniya Clark, RBT
• Darsha Darlene Clark, LPC
• Erica Clark, LPC
• Telisha Niketia Clark
• Torey B Clark, M.D.
• Shannon Claxton
• Jonathan Clayton, MD
• Robert L Clemons II, LPC

• Counselor in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.