Active NPI
Resa Frederick, M.ED, NCC, LPC
- Counselor
- Mantachie, MS
National Provider Identifier
1376813022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 2052
- Practice address
- 720 Oak Grove Rd
Mantachie, MS 38855-8469 - Phone
- (662) 687-5994
- NPI assigned
- Jan 11, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Counselor | 101Y00000X | 2052 | MS | Primary |
Addresses
Primary practice location
720 Oak Grove Rd
Mantachie, MS 38855-8469
Mailing address
720 Oak Grove Rd
Mantachie, MS 38855-8469
Phone (662) 687-5994
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2052 | MS | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701129600000",
"number": "1376813022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 OAK GROVE RD",
"city": "MANTACHIE",
"state": "MS",
"postal_code": "388558469",
"telephone_number": "662-687-5994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 OAK GROVE RD",
"city": "MANTACHIE",
"state": "MS",
"postal_code": "388558469",
"telephone_number": "662-687-5994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "RESA",
"name_prefix": "Miss",
"credential": "M.ED, NCC, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-11",
"last_updated": "2023-11-28",
"certification_date": "2023-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MS",
"license": "2052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mantachie, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.