Kessa Mystique Stephenson-Taylor, AA, BA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1430 16TH Ave
Longview, WA 98632-2901

Phone

(360) 799-4556

NPI assigned

Feb 28, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kessa Mystique Shattuck Former name

Medicare fee-for-service enrollment

Enrolled in WA

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

Mental Health Counselor

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Pathways Mental Health ServicesGroup PAC ID 5496053803, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts, Bachelor of Arts

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 and National Provider Directory roles.

• Pathways Mental Health Services

  • Mental Health Counselor
  • Olympia, WA
  • NPI 1306004775
  Medicare reassignment Care Compare group NPD
• Victory Healthcare LLC

  • Family Medicine Physician
  • Longview, WA
  • NPI 1467220871
  NPD

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578441600000",
    "number": "1255833885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 CALVIN RD",
            "city": "CINEBAR",
            "state": "WA",
            "postal_code": "985339700",
            "telephone_number": "360-520-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 16TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322901",
            "telephone_number": "360-799-4556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4804 Lacey Blvd SE Ste A",
            "address_purpose": "LOCATION",
            "city": "Lacey",
            "state": "WA",
            "postal_code": "985035733",
            "country_code": "US",
            "telephone_number": "360-799-5782",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3857 Martin Way E",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "98506",
            "country_code": "US",
            "telephone_number": "360-704-7170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEPHENSON-TAYLOR",
        "first_name": "KESSA",
        "middle_name": "MYSTIQUE",
        "credential": "AA, BA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-28",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KESSA",
            "last_name": "SHATTUCK",
            "middle_name": "MYSTIQUE",
            "credential": "AA, BA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Caleb Daniel Steele
• Guy Steele, CPC
• Kenneth Eugene Steidley, DMD
• Honnalore Byrdeen Steissberg, MSW
• Joanna Louise Wagner Stenzel, RPH
• Sandra Sterling
• Robert Stevens, HIS
• Constance M Stevenson
• Hailey Stewart
• Jessica Lynn Stickley, MS, MHP

• Mental Health Counselor in Longview, WA
• Providers in Longview, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.