Individual provider Active NPI

Demelza Victoria Stoudt, LPCC , NCC

  • Professional Counselor
  • Moraine, OH
National Provider Identifier
1629373683
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E.1400439 Issued in OH
Practice address
3095 Kettering Blvd
Moraine, OH 45439-1983
Phone
(937) 293-8300
NPI assigned
Jan 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X E.1400439 OH Primary

Addresses

Primary practice location

3095 Kettering Blvd
Moraine, OH 45439-1983

Mailing address

3095 Kettering Blvd
Moraine, OH 45439-1983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240124003317 OH Practitioner - Mental Health Counselor 0345693503 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Butler Behavioral Health Services, Inc. CurrentSince Jan 10, 2024 Accepting new patients
Nova Behavioral Health, Inc. Past Accepting new patients
Nova Behavioral Health, Inc PastSince Dec 1, 2016 Accepting new patients

Locations

1490 University Blvd
Hamilton, OH 45011
Phone (513) 867-5400

1502 University Blvd
Ste D
Hamilton, OH 45011

1490 University Blvd
Ste A
Hamilton, OH 45011

212 Cook Rd
Lebanon, OH 45036
Phone (513) 695-1354

1131 Manchester Ave
Middletown, OH 45042
Phone (513) 422-4004

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/bbhs/r4/
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1629373683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391983",
            "telephone_number": "937-293-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUDT",
        "first_name": "DEMELZA",
        "middle_name": "VICTORIA",
        "credential": "LPCC , NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-21",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1400439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moraine, OH

Sources for this page

Verify at the official NPI Registry.