Active NPI
Theresa Flanagan Fordham, LPC LSW
- Professional Counselor
- Biloxi, MS
National Provider Identifier
1730273335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0934
- Practice address
- 1636 Popps Ferry Rd Ste 116
Biloxi, MS 39532 - Phone
- (228) 596-9903
- Fax
- (228) 396-5001
- NPI assigned
- Oct 3, 2006
- Last updated
- Jan 19, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0934 | MS | Primary |
| Social Worker | 104100000X | W4171 | MS |
Addresses
Primary practice location
1636 Popps Ferry Rd Ste 116
Biloxi, MS 39532
Mailing address
PO Box 7884
Gulfport, MS 39506
Phone (228) 596-9903
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A931421 | Other | MS | VALUE OPTIONS |
| 472900000 | Other | MS | MAGELLAN HEALTH |
Other names 1
- Teresa Flanagan Staley
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0934 | MS | MD | Professional Counselor |
| W4171 | MS | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484784000000",
"number": "1730273335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7884",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39506",
"telephone_number": "228-596-9903",
"fax_number": "228-396-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1636 POPPS FERRY RD STE 116",
"city": "BILOXI",
"state": "MS",
"postal_code": "39532",
"telephone_number": "228-596-9903",
"fax_number": "228-396-5001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORDHAM",
"first_name": "THERESA",
"middle_name": "FLANAGAN",
"name_prefix": "Ms.",
"credential": "LPC LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2017-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MS",
"license": "0934",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MS",
"license": "W4171",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "A931421",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN HEALTH",
"identifier": "472900000",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TERESA",
"last_name": "STALEY",
"middle_name": "FLANAGAN",
"credential": "LPC LSW MAC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Biloxi, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.