Individual provider Active NPI

Everick Scott Lesane, PHD, LPC

  • Mental Health Counselor
  • McDonough, GA
National Provider Identifier
1902218134
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LPC006164 Issued in GA
Practice address
200 W Campground Rd
McDonough, GA 30253-8002
Phone
(404) 795-2111
NPI assigned
May 22, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LPC006164 GA Primary

Addresses

Primary practice location

200 W Campground Rd
McDonough, GA 30253-8002

Mailing address

100 Postmaster Dr
#3092
McDonough, GA 30253-2838
Phone (404) 795-2111

Other identifiers 1

IdentifierTypeStateIssuer
003175654AMedicaidGA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250718001310 GA Practitioner - Mental Health Counselor 4688180599 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Mercer University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

115 Pine Shoals TRL
Fayetteville, GA 30215-4959
Phone (404) 717-7720

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
LPC006164GAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
MH Practice and Billing LLC Mental Health CurrentSince May 6, 2025 Accepting new patients

Locations

175 Corporate Center Dr
Ste B
Stockbridge, GA 30281
Phone (470) 275-2358

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476748800000",
    "number": "1902218134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 POSTMASTER DR",
            "address_2": "#3092",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302532838",
            "telephone_number": "404-795-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W CAMPGROUND RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302538002",
            "telephone_number": "404-795-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESANE",
        "first_name": "EVERICK",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-22",
        "last_updated": "2016-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC006164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003175654A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

Verify at the official NPI Registry.