Individual provider Active NPI

Stacey Shunay Staten

  • Professional Counselor
  • Arlington, TX
National Provider Identifier
1316637101
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
84694 Issued in TX
Practice address
6419 Twin Spruce CT
Arlington, TX 76018-2943
Phone
(940) 642-3822
NPI assigned
May 15, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 84694 TX Primary

Addresses

Primary practice location

6419 Twin Spruce CT
Arlington, TX 76018-2943

Mailing address

6419 Twin Spruce CT
Arlington, TX 76018-2943

Other practice location 1

1534 N Hampton Rd Ste 200
DeSoto, TX 75115-2493
Phone (469) 941-4067

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20240624003398 TX Practitioner - Mental Health Counselor 8123561784 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Amazing Counseling and Rehabilitation Services, Incorporated Professional CurrentSince May 9, 2024 Accepting new patients
Shine Medical Providers PC Past Accepting new patients

Locations

1534 N Hampton Rd
Ste A
Desoto, TX 75115
Phone (469) 941-4067

1534 N Hampton Rd
#200
Desoto, TX 75115
Phone (469) 941-4067

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1316637101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6419 TWIN SPRUCE CT",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760182943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6419 TWIN SPRUCE CT",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760182943",
            "telephone_number": "940-642-3822"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1534 N Hampton Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "DeSoto",
            "state": "TX",
            "postal_code": "751152493",
            "country_code": "US",
            "telephone_number": "469-941-4067",
            "fax_number": "469-941-4091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STATEN",
        "first_name": "STACEY",
        "middle_name": "SHUNAY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "84694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, TX

Sources for this page

Verify at the official NPI Registry.