Stacey Wyant, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

149.011158 Issued in IL

Practice address

311 E Main St
Suite 420
Galesburg, IL 61401-4855

Phone

(563) 265-5202

NPI assigned

Nov 17, 2015

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 names 1

• Stacey Miller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Grounded Perspectives, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Galesburg, IL
  • NPI 1457813842
  NPD Authorized official

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554422400000",
    "number": "1376917161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 E MAIN ST STE 205",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614014878",
            "telephone_number": "309-297-4911",
            "fax_number": "309-265-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 E MAIN ST",
            "address_2": "SUITE 420",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614014855",
            "telephone_number": "563-265-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYANT",
        "first_name": "STACEY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-17",
        "last_updated": "2019-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "149.011158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "MILLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Woltz, PHARMD
• Sandra Lynn Wood, QMHP,RN
• Woodridge of Galesburg LLC
• Hailey Worden
• Theresa Nicole Workheiser, LPCC
• Lawrence D Yee, LCPC
• Christine Marie Young, RN
• Chunrong Zhao
• Christina Anne Zolper

• Mental Health Counselor in Galesburg, IL
• Providers in Galesburg, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.

Verify at the official NPI Registry.