Active NPI
Stacy Christian Pettit, LPC
- Counselor
- Sidney, OH
National Provider Identifier
1336604966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- C.0900388
- Practice address
- 413 S Wagner Ave
Sidney, OH 45365-2562 - Phone
- (937) 726-3900
- NPI assigned
- Feb 7, 2019
- Last updated
- Feb 7, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | C.0900388 | OH | Primary |
Addresses
Primary practice location
413 S Wagner Ave
Sidney, OH 45365-2562
Mailing address
413 S Wagner Ave
Sidney, OH 45365-2562
Phone (937) 726-3900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C.0900388 | OH | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549497600000",
"number": "1336604966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 S WAGNER AVE",
"city": "SIDNEY",
"state": "OH",
"postal_code": "453652562",
"telephone_number": "937-726-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 S WAGNER AVE",
"city": "SIDNEY",
"state": "OH",
"postal_code": "453652562",
"telephone_number": "937-726-3900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIT",
"first_name": "STACY",
"middle_name": "CHRISTIAN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-07",
"last_updated": "2019-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OH",
"license": "C.0900388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sidney, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.