Active NPI
Kelly Logan Stafford, LPC
- Professional Counselor
- Ridgeland, MS
National Provider Identifier
1578833521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1320
- Practice address
- 357 Towne Center PL
Suite 402
Ridgeland, MS 39157-4870 - Phone
- (601) 573-7908
- Fax
- (601) 510-9356
- NPI assigned
- Jan 9, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1320 | MS | Primary |
Addresses
Primary practice location
357 Towne Center PL
Suite 402
Ridgeland, MS 39157-4870
Mailing address
PO Box 2582
Madison, MS 39130-2582
Phone (601) 573-7908
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 |
|---|---|---|---|
| 1320 | MS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326067200000",
"number": "1578833521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2582",
"city": "MADISON",
"state": "MS",
"postal_code": "391302582",
"telephone_number": "601-573-7908",
"fax_number": "601-510-9356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "357 TOWNE CENTER PL",
"address_2": "SUITE 402",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391574870",
"telephone_number": "601-573-7908",
"fax_number": "601-510-9356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFORD",
"first_name": "KELLY",
"middle_name": "LOGAN",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-09",
"last_updated": "2012-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MS",
"license": "1320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgeland, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.