NPIMap

Organization Active NPI

Stacy Wright

Doing business as Faithful Counsel

  • Clinical Psychologist
  • Selma, IN
National Provider Identifier
1144732264
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20041886A Issued in IN
Legal business name
STACY WRIGHT
Doing business as
Faithful Counsel
Practice address
5505 S County Road 475 E
Selma, IN 47383-9678
Phone
(219) 714-7147
Fax
(219) 627-1887
NPI assigned
Oct 30, 2017
Last updated
Aug 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Authorized official

Name
Stacy L Wright, PSYD, HSPPNPI 1508817917
Title
Psychologist
Phone
(219) 714-7147

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Psychologist 103TC0700X 20041886A IN Primary
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

5505 S County Road 475 E
Selma, IN 47383-9678

Mailing address

5505 S County Road 475 E
Selma, IN 47383-9678
Phone (219) 714-7147

Other identifiers 3

IdentifierTypeStateIssuer
200813850AMedicaidIN
000000834190OtherINANTHEM BLUE CROSS BLUE SHIELD
669102OtherINBEACON HEALTH OPTIONS

Other names 1

  • Faithful Counsel Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1144732264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 S COUNTY ROAD 475 E",
            "city": "SELMA",
            "state": "IN",
            "postal_code": "473839678",
            "telephone_number": "219-714-7147",
            "fax_number": "219-627-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 S COUNTY ROAD 475 E",
            "city": "SELMA",
            "state": "IN",
            "postal_code": "473839678",
            "telephone_number": "219-714-7147",
            "fax_number": "219-627-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACY WRIGHT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "219-714-7147",
        "authorized_official_credential": "PSYD, HSPP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20041886A",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200813850A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "000000834190",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH OPTIONS",
            "identifier": "669102",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Faithful Counsel",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Selma, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.