Jessica L Soukup, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4690-C Issued in NV

Practice address

407 N Walsh St
Carson City, NV 89701-4268

Phone

(775) 720-8676

Fax

(775) 418-7636

NPI assigned

Aug 13, 2009

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Winnemucca, NV
  • NPI 1275623530
  NPD (past)

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

{
    "created_epoch": "1250121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1326270042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1064 RIDGEFIELD DR",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897064372",
            "telephone_number": "775-720-8676",
            "fax_number": "775-418-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 N WALSH ST",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897014268",
            "telephone_number": "775-720-8676",
            "fax_number": "775-418-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUKUP",
        "first_name": "JESSICA",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-13",
        "last_updated": "2022-12-02",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "4690-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4960-C",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Carson City, NV
• Providers in Carson City, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.