Ida Mae Boatman-Goussios, LPC
Mental Health Counselor (CMS) · Jefferson City, TN
At a glance
1413 Russell Ave, Jefferson City, TN 37760-2562
NPPES record updated Jan 2, 2025. Public records can lag behind changes at a practice.
Before you call: a quick checklist
- Are you accepting new patients?
- Do you accept my specific insurance plan?
- Do you provide the service I need at this address?
- Do I need a referral, and what is the earliest appointment?
Insurance participation and appointment availability are not established by these public records.
Medicare & insurance
Insurance participation is not established by these public records. Ask the practice and your insurer about your specific plan and this location.
How to check your coverage
Use your plan’s provider directory or the member-services number on your insurance card. Confirm the clinician, practice address, service, and whether a referral is required. A missing opt-out record does not establish Medicare acceptance.
Check the official Medicare directory ↗Practice location
1413 Russell AveJefferson City, TN 37760-2562
Additional reported practice locations
229 Hedrick DrNewport, TN 378212902
Phone: 4236231057
Fax: 4236258620 111 Mockingbird Ave
Parrottsville, TN 378432741
Phone: 4236251170
Fax: 4236253618 3222 Chestnut Hill School Rd
Dandridge, TN 377257238
Phone: 8655096611
Fax: 8655098811 103 Wilton Springs Rd
Newport, TN 378216405
Phone: 4234872222
Fax: 4236237787 100 Stoneforest Dr Ste 230
Woodstock, GA 301894903
Phone: 7703898100
Education & affiliations
- Medical / professional school
- Not reported in this file
- Graduation year
- 2002
- CMS specialties
- Mental Health Counselor
Practice groups
Graduation year does not establish years in practice. A reported affiliation does not establish employment, current admitting privileges, or insurance participation.
Source: CMS National Downloadable File · Published Oct 15, 2026.
Procedures in the public data
Reported activity can help you ask more informed questions about a practice’s services.
No displayed procedure-category record in this release. This does not mean the clinician performs no procedures.
CMS uses a one-year claims window with a reporting lag. Counts cover the Medicare activity included by CMS, not all patients. “1–10” is a published range. Volume is not a quality or outcomes score. Coverage and methodology
Source: CMS Utilization Data · Published Oct 15, 2026.
Service-mix comparison is unavailable for this NPI in the imported Medicare service file.
Industry-reported general payments
No matching general-payment summary in the imported release. This is not a verified zero and does not rule out other payment types or years.
Source: CMS 2025 payments grouped by covered recipient and nature of payments · Published Jun 30, 2026.
Professional details: NPI, taxonomy & registry record
Registry details
- Primary taxonomy
- Mental Health Counselor (CMS)
- Taxonomy code
- 101YP2500X
- Enumeration date
- Jul 23, 2008
- Record updated
- Jan 2, 2025
More registry details
- Provider type
- Individual · Type 1
- Reported credentials
- LPC
Reported taxonomies and licenses
101YP2500X
License reported: LPC013160 GA
101YP2500X · Primary
License reported: 2267 TN
License numbers and credentials are reported to NPPES; HCPList does not independently verify them.
Practice location
1413 Russell AveJefferson City, TN 37760-2562
- Phone
- (865) 471-5525
Mailing address
PO BOX 577NEWPORT, TN 378220577
Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.
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