Active NPI
Jennifer Caudle
- Professional Counselor
- Granbury, TX
National Provider Identifier
1982208633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 80654
- Practice address
- 303 W Pearl St
Granbury, TX 76048-2451 - Phone
- (817) 578-0189
- NPI assigned
- Nov 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 80654 | TX | Primary |
Addresses
Primary practice location
303 W Pearl St
Granbury, TX 76048-2451
Mailing address
900 Dart CT
Granbury, TX 76049-1283
Phone (817) 578-0189
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80654 | TX | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willow Mark Therapy PLLC | Professional | Current | Accepting new patients |
Locations
303 W Pearl St
Granbury, TX 76048
Phone (817) 573-2601
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": "1606176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606176000000",
"number": "1982208633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 DART CT",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760491283",
"telephone_number": "817-578-0189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 W PEARL ST",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760482451",
"telephone_number": "817-578-0189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAUDLE",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-24",
"last_updated": "2020-11-24",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "80654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granbury, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.