Individual provider Active NPI

Cassandra Dickerson

  • Mental Health Counselor
  • Sioux City, IA
National Provider Identifier
1033507785
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
107652 Issued in IA
Practice address
700 4TH St Ste 220
Sioux City, IA 51101-1702
Phone
(712) 252-7170
Fax
(712) 252-1202
NPI assigned
Jan 5, 2015
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 107652 IA Primary

Addresses

Primary practice location

700 4TH St Ste 220
Sioux City, IA 51101-1702

Mailing address

3650 Glen Oaks Blvd
Sioux City, IA 51104-1546
Phone (712) 222-1459

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240918003672 IA Order and Referring Only - Mental Health Counselor 6002357977

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
107652IAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Turner Therapy & Counseling Social Worker CurrentSince Jul 7, 2024 Accepting new patients

Locations

3650 Glen Oaks Blvd
Sioux City, IA 51104
Phone (712) 222-1459

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1033507785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 GLEN OAKS BLVD",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511041546",
            "telephone_number": "712-222-1459",
            "fax_number": "712-222-1460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 4TH ST STE 220",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011702",
            "telephone_number": "712-252-7170",
            "fax_number": "712-252-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "CASSANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-05",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "107652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

Verify at the official NPI Registry.