Individual provider Active NPI

Kennerly Fox

  • Mental Health Counselor
  • Marietta, GA
National Provider Identifier
1962258707
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LPC014635 Issued in GA
Practice address
1650 County Services Pkwy SW
Marietta, GA 30008-4010
Phone
(404) 823-3308
NPI assigned
Apr 24, 2024
Last updated
Apr 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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 LPC014635 GA Primary

Addresses

Primary practice location

1650 County Services Pkwy SW
Marietta, GA 30008-4010

Mailing address

1650 County Services Pkwy SW
Marietta, GA 30008-4010
Phone (404) 823-3308

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
I20240815001805 GA Practitioner - Mental Health Counselor 0244778769 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1503 N Tibbs Rd
Dalton, GA 30720-2915
Phone (706) 270-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC014635GAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Highland Rivers CSB CurrentSince Apr 20, 2024 Accepting new patients
Highland Rivers Community Service Board CurrentSince Apr 20, 2024 Accepting new patients

Locations

191 Lamar Haley Pkwy
Canton, GA 30114
Phone (770) 704-1600

1503 N Tibbs Rd
Dalton, GA 30720
Phone (706) 229-4507

1650 County Services Pkwy SW
Marietta, GA 30008
Phone (770) 514-2300

Organizations & group practices 2

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": "1713916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1962258707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COUNTY SERVICES PKWY SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300084010",
            "telephone_number": "404-823-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COUNTY SERVICES PKWY SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300084010",
            "telephone_number": "404-823-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOX",
        "first_name": "KENNERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC014635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.