Renee Bernadette Ambush, IMS, LM

Primary specialty

Pastoral CounselorTaxonomy code 101YP1600X

Practice address

3156 Mount Zion Rd Apt 305
Stockbridge, GA 30281-4179

Phone

(443) 722-9488

NPI assigned

Oct 26, 2024

Sex

Female

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

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.

• Out Tha Box Foundation

  • Counselor
  • Stockbridge, GA
  • NPI 1326860834

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1729900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729900800000",
    "number": "1972325488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3156 MOUNT ZION RD APT 305",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814179",
            "telephone_number": "443-722-9488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 MOUNT ZION RD APT 305",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814179",
            "telephone_number": "443-722-9488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBUSH",
        "first_name": "RENEE",
        "middle_name": "BERNADETTE",
        "credential": "IMS, LM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-26",
        "last_updated": "2024-10-26",
        "certification_date": "2024-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pastoral Counselor in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Pastoral Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2024; 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.