Stacey Koekkoek

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

8490 Issued in MA

Legal business name

STACEY KOEKKOEK

Practice address

260 Boston Post Rd
Suite 11
Wayland, MA 01778-1889

Phone

(508) 276-1743

NPI assigned

Mar 27, 2014

Last updated

Apr 4, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stacey Koekkoek, MS RD, LDN, LMHCNPI 1982898177

Title

Psychotherapist/Dietitian

Phone

(508) 276-1743

Specialties & licenses 1

Addresses

Locations

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.

• Stacey Koekkoek, MS RD, LDN, LMHC

  • Registered Dietitian
  • Wayland, MA
  • NPI 1982898177
  NPD (past) Authorized official

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1316364375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 BOSTON POST RD",
            "address_2": "SUITE 11",
            "city": "WAYLAND",
            "state": "MA",
            "postal_code": "017781889",
            "telephone_number": "508-276-1743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 BOSTON POST RD",
            "address_2": "SUITE 11",
            "city": "WAYLAND",
            "state": "MA",
            "postal_code": "017781889",
            "telephone_number": "508-276-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACEY KOEKKOEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-27",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "KOEKKOEK",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST/DIETITIAN",
        "authorized_official_telephone_number": "508-276-1743",
        "authorized_official_credential": "MS RD, LDN, LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "8490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Trace Slater, PH.D.
• Diane Marie Smith, P.T.A.
• Jonathan G Smith, M.D.
• Arnold Lawrence Sperling, M.D.
• Nicole J Spiewak, LICSW
• Ciara Staunton
• Greta Gay Stone, LMHC
• Arthur Lee Strafuss
• Laurence James Stybel, ED.D.
• Sudbury Racquet Club Inc. (The Longfellow Club)

• Mental Health Counselor in Wayland, MA
• Providers in Wayland, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; 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.