Active NPI
Nicole Stackpole, LPC, R-DMT
- Counselor
- Buda, TX
National Provider Identifier
1639719974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 79813
- Practice address
- 112 Cimarron Park Loop Ste B
Buda, TX 78610-2850 - Phone
- (512) 643-0840
- NPI assigned
- Jan 15, 2020
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 79813 | TX | Primary |
Addresses
Primary practice location
112 Cimarron Park Loop Ste B
Buda, TX 78610-2850
Mailing address
2915 Aftonshire Way Apt 9301
Austin, TX 78748-5883
Phone (512) 643-0840
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 |
|---|---|---|---|
| 79813 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579046400000",
"number": "1639719974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2915 AFTONSHIRE WAY APT 9301",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787485883",
"telephone_number": "512-643-0840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 CIMARRON PARK LOOP STE B",
"city": "BUDA",
"state": "TX",
"postal_code": "786102850",
"telephone_number": "512-643-0840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACKPOLE",
"first_name": "NICOLE",
"credential": "LPC, R-DMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-15",
"last_updated": "2020-01-15",
"certification_date": "2020-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "79813",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buda, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.