Mistie Ann Tennant, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.012771 Issued in IL

Practice address

115 Lincoln Place CT Ste 102
Belleville, IL 62221

Phone

(314) 643-8664

Fax

(614) 416-1401

NPI assigned

Feb 24, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• New Seasons Counseling

  • Community/Behavioral Health Agency
  • Belleville, IL
  • NPI 1255104212
  NPD

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

{
    "created_epoch": "1582502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1265066880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 LINCOLN PLACE CT STE 102",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622215876",
            "telephone_number": "314-643-8664",
            "fax_number": "618-416-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 LINCOLN PLACE CT STE 102",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "62221",
            "telephone_number": "314-643-8664",
            "fax_number": "614-416-1401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 Frank Scott Pkwy W Ste 990",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622235000",
            "country_code": "US",
            "telephone_number": "618-236-6501",
            "fax_number": "618-236-6551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TENNANT",
        "first_name": "MISTIE",
        "middle_name": "ANN",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-24",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.012771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• TDL Group, Inc.
• TDL Group, Inc.
• Heidi Tedder
• Kemuel Ezekiel Telemaque, MD
• Ten Broeck Tennessee Physicians Group Inc
• Teresa Schroeder LLC
• Mary Kathryn Terrell, B.A.
• Tianna Terry, DOULA
• The Country Doctor, LTD.
• The Ease Program

• Mental Health Counselor in Belleville, IL
• Providers in Belleville, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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.