Active NPI
Stacie Henson, LPC
- Professional Counselor
- Saint Louis, MO
National Provider Identifier
1013484443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2015043798
- Practice address
- 9378 Olive Blvd Ste 317
Saint Louis, MO 63132-3224 - Phone
- (314) 994-9344
- NPI assigned
- Oct 24, 2018
- 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 | 2015043798 | MO | Primary |
Addresses
Primary practice location
9378 Olive Blvd Ste 317
Saint Louis, MO 63132-3224
Mailing address
415 Cedar Oak CT
Saint Peters, MO 63376-1737
Phone (636) 448-7586
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 |
|---|---|---|---|
| 2015043798 | MO | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jerry Waggoner LPC L.L.C. | Past | Accepting new patients |
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.
-
- Community/Behavioral Health Agency
- Lake Saint Louis, MO
- NPI 1548546583
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540339200000",
"number": "1013484443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 CEDAR OAK CT",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633761737",
"telephone_number": "636-448-7586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9378 OLIVE BLVD STE 317",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631323224",
"telephone_number": "314-994-9344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENSON",
"first_name": "STACIE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-24",
"last_updated": "2018-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2015043798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.