NPIMap

Individual provider Active NPI

Mary Kaye Tacker, PHD, LMFT, LADC

  • Marriage & Family Therapist
  • St. Cloud, MN
National Provider Identifier
1629269626
Registry record updated Jan 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1490 Issued in MN
Practice address
1406 6TH Avenue North
St. Cloud Hospital
St. Cloud, MN 56303-1901
Phone
(320) 251-2700
Fax
(320) 229-5109
NPI assigned
Aug 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 1490 MN Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 301691 MN

Addresses

Primary practice location

1406 6TH Avenue North
St. Cloud Hospital
St. Cloud, MN 56303-1901

Mailing address

1900 Centracare Cir # 2475
Centra Care Health Plaza
Saint Cloud, MN 56303-5000
Phone (320) 229-5199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240723003664 MN Practitioner - Marriage and Family Therapist 5698211928 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 251-2700

1900 Centracare Cir
Saint Cloud, MN 56303-5000
Phone (320) 654-3630

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
301691MNMDAddiction (Substance Use Disorder) Counselor
1490MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Cloud Hospital CurrentSince Jul 9, 2024 Accepting new patients
St. Cloud Hospital CurrentSince Jul 9, 2024 Accepting new patients
Centracare Clinic CurrentSince Jul 1, 2024 Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Jul 1, 2024 Accepting new patients
St. Cloud Hospital Past Accepting new patients

Locations

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
#2475
Saint Cloud, MN 56303
Phone (320) 229-4977

110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375

Interoperability endpoints

  • Direct secure messaging: mtacker957@direct.centracare.com

Organizations & group practices 6

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358467200000",
    "number": "1629269626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR # 2475",
            "address_2": "CENTRA CARE HEALTH PLAZA",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-229-5199",
            "fax_number": "320-229-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVENUE NORTH",
            "address_2": "ST. CLOUD HOSPITAL",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "563031901",
            "telephone_number": "320-251-2700",
            "fax_number": "320-229-5109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKER",
        "first_name": "MARY",
        "middle_name": "KAYE",
        "credential": "PHD, LMFT, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-05",
        "last_updated": "2013-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "1490",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "301691",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St. Cloud, MN

Sources for this page

Verify at the official NPI Registry.