Active NPI
Kimberly Sue Nielsen
- Mental Health Counselor
- Mansfield, TX
National Provider Identifier
1063188241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 86040
- Practice address
- 1285 N Main St Ste 101-5
Mansfield, TX 76063-1511 - Phone
- (682) 651-7621
- NPI assigned
- Aug 18, 2021
- Last updated
- May 21, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Mental Health Counselor | 101YM0800X | 86040 | TX | Primary |
Addresses
Primary practice location
1285 N Main St Ste 101-5
Mansfield, TX 76063-1511
Mailing address
380 Solon Rd Apt 512
Waxahachie, TX 75165-1442
Phone (214) 675-9243
Other practice location 1
380 Solon Rd Apt 512
Waxahachie, TX 75165-1442
Phone (214) 675-9243
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 |
|---|---|---|---|
| 86040 | TX | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regal Oak Counseling, LLC | Mental Health | Past | Accepting new patients |
| Sotm Life Skills Center, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Counselor
- Mansfield, TX
- NPI 1730553975
-
- Mental Health Counselor
- Duncanville, TX
- NPI 1578979027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716249600000",
"number": "1063188241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "380 SOLON RD APT 512",
"city": "WAXAHACHIE",
"state": "TX",
"postal_code": "751651442",
"telephone_number": "214-675-9243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1285 N MAIN ST STE 101-5",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760631511",
"telephone_number": "682-651-7621"
}
],
"practiceLocations": [
{
"address_1": "380 Solon Rd Apt 512",
"address_purpose": "LOCATION",
"city": "Waxahachie",
"state": "TX",
"postal_code": "751651442",
"country_code": "US",
"telephone_number": "214-675-9243",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NIELSEN",
"first_name": "KIMBERLY",
"middle_name": "SUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-18",
"last_updated": "2024-05-21",
"certification_date": "2024-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "86040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.