Active NPI
Stacy Grant, LPC
- Professional Counselor
- Cedar Park, TX
National Provider Identifier
1558020354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 60926
- Practice address
- 201 S Lakeline Blvd Ste 103
Cedar Park, TX 78613-2719 - Phone
- (512) 843-3852
- NPI assigned
- Dec 9, 2021
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 60926 | TX | Primary |
Addresses
Primary practice location
201 S Lakeline Blvd Ste 103
Cedar Park, TX 78613-2719
Mailing address
201 S Lakeline Blvd Ste 103
Cedar Park, TX 78613-2719
Phone (512) 843-3852
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 17, 2024 through May 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60926 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639008000000",
"number": "1558020354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 S LAKELINE BLVD STE 103",
"city": "CEDAR PARK",
"state": "TX",
"postal_code": "786132719",
"telephone_number": "512-843-3852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 S LAKELINE BLVD STE 103",
"city": "CEDAR PARK",
"state": "TX",
"postal_code": "786132719",
"telephone_number": "512-843-3852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "STACY",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-09",
"last_updated": "2021-12-09",
"certification_date": "2021-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "60926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedar Park, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.