IDA MAE BOATMAN-GOUSSIOS LPC NPI 1346405958

NPI Information

  • NPI: 1346405958
  • Provider Name: IDA MAE BOATMAN-GOUSSIOS, LPC
  • Classification: Counselor - 101YP2500X
  • Specialization: Professional
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1413 RUSSELL AVE
    JEFFERSON CITY, TN
    ZIP 37760
  • Phone: (865) 471-5525

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NPI Details

Ida Mae Boatman-goussios, LPC is a professional counselor in Jefferson City, TN with 24 years of experience. Ida Mae Boatman-goussios, LPC NPI is 1346405958. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1413 RUSSELL AVE
JEFFERSON CITY, TN
ZIP 37760-562
Phone: (865) 471-5525

The NPI 1346405958 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 7/23/2008 and was last updated on 1/2/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YP2500XCounselorProfessionalLPC013160GEORGIANo
2101YP2500XCounselorProfessional2267TENNESSEEYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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