Active NPI
Stacey Matthews Overstreet
- Professional Counselor
- Jackson, MS
National Provider Identifier
1841010915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P1214
- Practice address
- 1437 Old Square Rd Ste 101
Jackson, MS 39211-5533 - Phone
- (601) 977-9353
- NPI assigned
- Oct 14, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | P1214 | MS | Primary |
Addresses
Primary practice location
1437 Old Square Rd Ste 101
Jackson, MS 39211-5533
Mailing address
580 S Pear Orchard Rd Apt 1708
Ridgeland, MS 39157-4219
Phone (601) 842-0645
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 |
|---|---|---|---|
| P1214 | MS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728864000000",
"number": "1841010915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "580 S PEAR ORCHARD RD APT 1708",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391574219",
"telephone_number": "601-842-0645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1437 OLD SQUARE RD STE 101",
"city": "JACKSON",
"state": "MS",
"postal_code": "392115533",
"telephone_number": "601-977-9353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OVERSTREET",
"first_name": "STACEY",
"middle_name": "MATTHEWS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-14",
"last_updated": "2024-10-14",
"certification_date": "2024-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "MS",
"license": "P1214",
"primary": true
}
],
"identifiers": [],
"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 Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.