IDA MAE BOATMAN-GOUSSIOS LPC
NPI 1346405958
Counselor - Professional in Jefferson City, TN

Active since July 23, 2008PECOS EnrolledAccepts Medicare Assignment
1413 RUSSELL AVE, JEFFERSON CITY, TN 37760(865) 471-5525 Get Directions Write a Review

NPPES record last updated: January 2, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 2, 2025, Mar 17, 2018, Feb 20, 2018 (3 updates tracked since 2018).

About Ida Mae Boatman-goussios Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IDA MAE BOATMAN-GOUSSIOS LPC (NPI 1346405958) is an individual professional provider in Jefferson City, Tennessee, licensed in Tennessee (2267) and active in the NPI registry since July 2008. She is enrolled in Medicare PECOS, maintains 5 additional practice locations, and is a graduate of Other (2002).

NPPES Registry Identity

NPI1346405958
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameIDA MAE BOATMAN-GOUSSIOSCredential: LPC
Location Address1413 RUSSELL AVEJefferson City, TN 37760-2562
Mailing AddressPo Box 577Newport, TN 37822-0577 · (423) 613-3300 · Fax (423) 623-4088
Sole ProprietorNo
Medical School CMSOtherGraduated 2002
Enumeration DateJuly 23, 2008
Last NPPES UpdateJanuary 2, 20253 updates tracked since enumeration
NPPES CertifiedJanuary 2, 2025
NPI 1346405958 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
Licenses Licensed in TN · 2267 Licensed in GA · LPC013160
1413 RUSSELL AVE, Jefferson City, TN 37760

Secondary Practice Locations 5

Location 1229 Hedrick DrNewport, TN 37821-2902 · Phone (423) 623-1057 · Fax (423) 625-8620
Location 2111 Mockingbird AveParrottsville, TN 37843-2741 · Phone (423) 625-1170 · Fax (423) 625-3618
Location 33222 Chestnut Hill School RdDandridge, TN 37725-7238 · Phone (865) 509-6611 · Fax (865) 509-8811
Location 4103 Wilton Springs RdNewport, TN 37821-6405 · Phone (423) 487-2222 · Fax (423) 623-7787
Location 5100 Stoneforest Dr Ste 230Woodstock, GA 30189-4903 · Phone (770) 389-8100

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Ida Mae Boatman-goussios Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2567991284
PECOS Enrollment IDI20250124003085
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine
1413 RUSSELL AVE
JEFFERSON CITY, TN 37760
Nurse Practitioner (Family)
1413 RUSSELL AVE
JEFFERSON CITY, TN 37760
Clinic/Center (Federally Qualified Health Center (FQHC))
1413 RUSSELL AVE
JEFFERSON CITY, TN 37760
Family Medicine
1413 RUSSELL AVE
JEFFERSON CITY, TN 37760
Clinic/Center
1413 RUSSELL AVE
JEFFERSON CITY, TN 37760
Clinic/Center
1413 RUSSELL AVE
JEFFERSON CITY, TN 37760

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ida Boatman-goussios's NPI number?

The NPI number for Ida Boatman-goussios is 1346405958. It was assigned to this individual provider in the NPPES registry on July 23, 2008.

Where is Ida Boatman-goussios located?

Ida Boatman-goussios practices at 1413 Russell Ave, Jefferson City, TN 37760. The listed phone number is (865) 471-5525.

What is Ida Boatman-goussios's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Ida Boatman-goussios enrolled in Medicare?

Yes. Ida Boatman-goussios is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Ida Boatman-goussios accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of North Carolina and 3 other insurers list Ida Boatman-goussios as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ida Boatman-goussios was last updated on January 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.