Jimmy Ballard Harrell, HSP-PA

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

1514 Issued in NC

Practice address

1706 Wayne Memorial Dr
Goldsboro, NC 27534-2240

Phone

(919) 734-6676

Fax

(919) 734-9050

NPI assigned

Jun 11, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Wayne Cares Inc.

  • Voluntary or Charitable Agency
  • Goldsboro, NC
  • NPI 1518414465
  NPD (past)
• Waynesboro Family Clinic

  • Mental Health Counselor
  • Goldsboro, NC
  • NPI 1760417570
  NPD (past)

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1972096451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275342240",
            "telephone_number": "919-734-6676",
            "fax_number": "919-734-9050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275342240",
            "telephone_number": "919-734-6676",
            "fax_number": "919-734-9050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRELL",
        "first_name": "JIMMY",
        "middle_name": "BALLARD",
        "credential": "HSP-PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-11",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NC",
            "license": "1514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Tatum Hardison
• Peggy Sue Harlan, RD
• Stacia Marie Harlan, LPCA
• Harmony Clinic, PLLC
• Annawyn Harrell, PHARMD
• Melissa Collins Harrell, LPC
• Harris Teeter LLC
• Tomeka Harris
• Cheryl Ann Harrison, LCSW, LPC
• David Leonard Harshman, M.D.

• Cognitive & Behavioral Psychologist in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Cognitive & Behavioral Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.