Stacey Kay Mock

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

260182 Issued in KY

Practice address

433 Shelton LN
Russellville, KY 42276-7600

Phone

(270) 901-5000

NPI assigned

Apr 12, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kentucky Counseling Center LLCGroup PAC ID 7618221300, 57 clinicians

KW Consulting LLCGroup PAC ID 6901291756, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kentucky Counseling Center, LLC

  • Counselor
  • Louisville, KY
  • NPI 1932590338
  Medicare reassignment Care Compare group NPD
• KW Consulting, LLC

  dba Fuller Life Counseling

  • Mental Health Counselor
  • Bowling Green, KY
  • NPI 1679127781
  Medicare reassignment Care Compare group NPD
• Lifeskills, Inc.

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1669401816
  Medicare reassignment NPD

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

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1154901361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 SUWANNEE TRAIL ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037956",
            "telephone_number": "270-901-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 SHELTON LN",
            "city": "RUSSELLVILLE",
            "state": "KY",
            "postal_code": "422767600",
            "telephone_number": "270-901-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOCK",
        "first_name": "STACEY",
        "middle_name": "KAY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-12",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "260182",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joe V Massa, LPA
• David L McClain, ARNP
• Chad Meacham, CRNA
• Jeffrey Meade, LPCC
• Kristin Mitchell, RN
• Morgan Mudd, M.S. CCC-SLP
• Amber Nagornay, APRN
• Dana Karen Northern, MD
• Wendy Oliver, PHARMD
• Orthopedics Plus Physical Therapy

• Clinical Social Worker in Russellville, KY
• Providers in Russellville, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.