NPIMap

Organization Active NPI

Stacy J Nielsen, LCSW, LLC

  • Community/Behavioral Health Agency
  • Winston, OR
National Provider Identifier
1861843310
Registry record updated Jun 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
L6376 Issued in OR
Legal business name
STACY J NIELSEN, LCSW, LLC
Practice address
11 SW Brantley Dr
Winston, OR 97496-4526
Phone
(541) 679-0366
NPI assigned
Jun 27, 2016
Last updated
Jun 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacy Jean Nielsen, LCSWNPI 1659608115
Title
Owner
Phone
(541) 802-6597

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X L6376 OR Primary

Addresses

Primary practice location

11 SW Brantley Dr
Winston, OR 97496-4526

Mailing address

11 SW Brantley Dr
Winston, OR 97496
Phone (541) 679-0366

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1466985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466985600000",
    "number": "1861843310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 SW BRANTLEY DR",
            "city": "WINSTON",
            "state": "OR",
            "postal_code": "97496",
            "telephone_number": "541-679-0366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 SW BRANTLEY DR",
            "city": "WINSTON",
            "state": "OR",
            "postal_code": "974964526",
            "telephone_number": "541-679-0366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACY J NIELSEN, LCSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-27",
        "last_updated": "2016-06-27",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-802-6597",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "L6376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; 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.