Keisa Ayana Brooks-Bacote

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC008161 Issued in GA

Practice address

431 Edgar Cir
Thomson, GA 30824-1600

Phone

(864) 554-1453

NPI assigned

Feb 27, 2007

Last updated

Mar 8, 2024By 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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA

  Medicare reassignment NPD

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709856000000",
    "number": "1932235322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 EDGAR CIR",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "308241600",
            "telephone_number": "864-554-1453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 EDGAR CIR",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "308241600",
            "telephone_number": "864-554-1453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS-BACOTE",
        "first_name": "KEISA",
        "middle_name": "AYANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayeaka Canton-Quiana Bracken, RBT
• Virginia R Bradshaw, NP
• Brandon a Coussens LMFT LLC
• Valena Denise Brinkley, NURSE PRACTITIONER
• Amanda Nicole Britt, M.D.
• Charles W Brunson, D.M.D.
• Bryant and London LLC
• Bryant and London LLC (Barney's Pharmacy)
• Burke Hospital Company (Southeastern Spine and Pain)
• Stephanie Theresa Burnett, NP-C

• Professional Counselor in Thomson, GA
• Providers in Thomson, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.