Mary Vixaisack, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

71432 Issued in TX

Practice address

937 Golden Grove Dr
Lewisville, TX 75067-6118

Phone

(214) 566-8777

NPI assigned

Jun 13, 2018

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: maryvixaisack@tdh.allscriptsdirect.net

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.

• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Professional

  NPD
• Rayl Enterprises

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fort Worth, TX
  • NPI 1891044228

  Professional

  NPD (past)

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

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1780177832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "937 GOLDEN GROVE DR",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750676118",
            "telephone_number": "214-566-8777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "937 GOLDEN GROVE DR",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750676118",
            "telephone_number": "214-566-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIXAISACK",
        "first_name": "MARY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-13",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "71432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vintage Family Medicine and Pediatrics
• Visionworks Inc
• Visionworks, Inc.
• Vista Ridge Operations, LLC
• Vista Ridge TX LLC
• Alicia Vo, PHARMD
• Vidhi Nirmit Vyas-Desai, PT, DPT
• W. Main Street Dental Lewisville, TX, P.C.
• Brittany Waddell, LMSW
• Emily Waddell, BCBA

• Professional Counselor in Lewisville, TX
• Providers in Lewisville, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.

Verify at the official NPI Registry.