Lydia M. Staten, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C0715 Issued in MS

Practice address

1225 N West St
Jackson, MS 39202-2056

Phone

(601) 540-7105

NPI assigned

May 12, 2007

Last updated

May 25, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Lydia Eleanor Millwood Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1178928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337904000000",
    "number": "1679788616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 HIGHWAY 80 WEST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392042056",
            "telephone_number": "601-540-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 N WEST ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022056",
            "telephone_number": "601-540-7105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATEN",
        "first_name": "LYDIA",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-12",
        "last_updated": "2012-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "C0715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120550",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYDIA",
            "last_name": "MILLWOOD",
            "middle_name": "ELEANOR",
            "prefix": "MRS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• State of Mississippi-University of Ms Medical Center
• State of Ms - University of Ms Medical Center (University Physicians, PLLC)
• State of Ms Umc Newborn Transport
• State Veterans Affairs Board
• State Veterans Affairs Board
• Desiree States, CSS
• Statewide Healthcare Services (Oxford Healthcare)
• Statewide Healthcare Services, Inc
• Statewide Healthcare Services, Inc
• Statewide Healthcare Services, Inc (Oxford Healthcare)

• Mental Health Counselor in Jackson, MS
• Providers in Jackson, MS by specialty
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.

Verify at the official NPI Registry.