Staci Koetter, LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

1501 Brook Ave
Wichita Falls, TX 76301-5657

Phone

(940) 723-4488

NPI assigned

Dec 2, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Micah Boyer MDGroup PAC ID 8426482159, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Micah Boyer MD

  • Family Medicine Physician
  • Wichita Falls, TX
  • NPI 1114564085
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788739200000",
    "number": "1366089054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 BROOK AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015657",
            "telephone_number": "940-400-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 BROOK AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015657",
            "telephone_number": "940-723-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOETTER",
        "first_name": "STACI",
        "credential": "LPC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-02",
        "last_updated": "2026-09-07",
        "certification_date": "2026-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Treva Knight, RN
• Christopher Koetter
• Drew C Koetter, DPT
• Monica D Koetter, NP
• Sarah Leigh Koetter
• Cynthia Raye Komatz, LCDC
• Clement Konadu, PMHNP-BC
• Rita Kong, M.D.
• Soe-Ni Nicholas Kong, M.D.
• Sunil Kongara, M.D.

• Professional Counselor in Wichita Falls, TX
• Providers in Wichita Falls, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.