Tracy Lee Mattingly-Miller, LPCC,NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

105746 Issued in KY

Practice address

1421 Lexington Rd
Richmond, KY 40475-1059

Phone

(859) 624-2454

Fax

(859) 624-2454

NPI assigned

Nov 24, 2015

Last updated

May 26, 2016By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brightside Medical PCGroup PAC ID 6608262464, 274 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brightside Medical, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1801355482

  KY

  Medicare reassignment Care Compare group NPD
• Mindpsi: School Psychological Services, PLLC

  • Clinical Psychologist
  • Richmond, KY
  • NPI 1245498872
  NPD (past)

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

{
    "created_epoch": "1448323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464220800000",
    "number": "1790159002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 BOGGS RD",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407447204",
            "telephone_number": "606-657-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 LEXINGTON RD",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404751059",
            "telephone_number": "859-624-2454",
            "fax_number": "859-624-2454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY-MILLER",
        "first_name": "TRACY",
        "middle_name": "LEE",
        "credential": "LPCC,NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-24",
        "last_updated": "2016-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "1205",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "105746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000991124",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah McConnell Mashburn, OTRL, CPAM
• Hallee Mason, PHARMD
• Monique Mathena
• Keeley Green Mathis, PHARMACIST
• Kailee Matthews
• Stephen P Mattingly, DMD
• Vonda Brock Mattingly, APRN, FNP-C
• Mae M Maupin-Story, R.D.
• Sarah Maxwell-Sammons, PA-C
• Kristen Rebecca Maynard, M.S., SLP

• Professional Counselor in Richmond, KY
• Providers in Richmond, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.