Active NPI
Maryam Clyburn, LPC
- Professional Counselor
- Grayson, GA
National Provider Identifier
1992380281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC001868
- Practice address
- 1128 Lakeview Rd
Grayson, GA 30017-1143 - Phone
- (770) 265-7076
- NPI assigned
- Mar 17, 2021
- 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 | LPC001868 | GA | Primary |
Addresses
Primary practice location
1128 Lakeview Rd
Grayson, GA 30017-1143
Mailing address
1128 Lakeview Rd
Grayson, GA 30017-1143
Phone (770) 978-9393
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1986
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1128 Lakeview Rd
Grayson, GA 30017-1143
367 Athens Hwy
Suite 1800
Loganville, GA 30052
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC001868 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615939200000",
"number": "1992380281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1128 LAKEVIEW RD",
"city": "GRAYSON",
"state": "GA",
"postal_code": "300171143",
"telephone_number": "770-978-9393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1128 LAKEVIEW RD",
"city": "GRAYSON",
"state": "GA",
"postal_code": "300171143",
"telephone_number": "770-265-7076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLYBURN",
"first_name": "MARYAM",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-17",
"last_updated": "2021-03-17",
"certification_date": "2021-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC001868",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grayson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.