Individual provider Active NPI

Stacie R Hensen, M.S.

  • Counselor
  • Cody, WY
National Provider Identifier
1295017820
Registry record updated Sep 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
1120 Beck Ave
Cody, WY 82414
Phone
(307) 578-7770
NPI assigned
Sep 9, 2011
Last updated
Sep 25, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

1120 Beck Ave
Cody, WY 82414

Mailing address

1120 Beck Ave.
Cody, WY 82414
Phone (307) 578-7770

Other names 1

  • Stacie R Jackson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
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

Enrollment IDStateProvider typePAC IDDetails
I20240606000880 WY Practitioner - Mental Health Counselor 5890237838 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Foundations Counselling LLCGroup PAC ID 4981146925, 3 clinicians

Practice addresses (Care Compare)

1527 Rumsey Ave
Cody, WY 82414-3813
Phone (307) 578-7770

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Foundations Counselling, LLC CurrentSince Apr 17, 2024 Accepting new patients

Locations

1527 Rumsey Ave
Cody, WY 82414
Phone (307) 578-7770

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1295017820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 BECK AVE.",
            "city": "CODY",
            "state": "WY",
            "postal_code": "82414",
            "telephone_number": "307-578-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 BECK AVE",
            "city": "CODY",
            "state": "WY",
            "postal_code": "82414",
            "telephone_number": "307-578-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENSEN",
        "first_name": "STACIE",
        "middle_name": "R",
        "credential": "M.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-09",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACIE",
            "last_name": "JACKSON",
            "middle_name": "R",
            "credential": "MS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cody, WY

Sources for this page

Verify at the official NPI Registry.