Active NPI
Stephanie Thomas, PCMHT
- Mental Health Counselor
- Jackson, MS
National Provider Identifier
1780120071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2763
- Practice address
- 460 Briarwood Dr
Suite 510
Jackson, MS 39206-3051 - Phone
- (601) 956-4816
- Fax
- (601) 956-4817
- NPI assigned
- Jan 11, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2763 | MS | Primary |
Addresses
Primary practice location
460 Briarwood Dr
Suite 510
Jackson, MS 39206-3051
Mailing address
460 Briarwood Dr
Suite 510
Jackson, MS 39206-3051
Phone (601) 956-4816
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01670076 | Medicaid | MS |
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 |
|---|---|---|---|
| 2763 | MS | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484092800000",
"number": "1780120071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 BRIARWOOD DR",
"address_2": "SUITE 510",
"city": "JACKSON",
"state": "MS",
"postal_code": "392063051",
"telephone_number": "601-956-4816",
"fax_number": "601-956-4817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 BRIARWOOD DR",
"address_2": "SUITE 510",
"city": "JACKSON",
"state": "MS",
"postal_code": "392063051",
"telephone_number": "601-956-4816",
"fax_number": "601-956-4817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "STEPHANIE",
"credential": "PCMHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-11",
"last_updated": "2017-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MS",
"license": "2763",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01670076",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.