Stephanie R Thacker, MA, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39005154A Issued in IN

Practice address

616 E Colfax Ave
Ste 2
South Bend, IN 46617-2827

Phone

(269) 985-8217

Fax

(844) 930-4791

NPI assigned

Oct 10, 2024

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

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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 and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  IN

  Medicare reassignment NPD

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

{
    "created_epoch": "1728518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1881414308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 E COLFAX AVE",
            "address_2": "STE 2",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46617",
            "telephone_number": "269-985-8217",
            "fax_number": "844-930-4791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 E COLFAX AVE",
            "address_2": "STE 2",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172827",
            "telephone_number": "269-985-8217",
            "fax_number": "844-930-4791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "STEPHANIE",
        "middle_name": "R",
        "credential": "MA, LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-10",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39005154A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emilee Tehrani, NP-C, RN
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• Ronnae Tessely, OT
• Cynthia Thai, MD
• Robert Daniel Thatcher
• The Center for the Homeless, Inc
• The Children's Campus, Inc.
• The Children's Campus, Inc.

• Mental Health Counselor in South Bend, IN
• Providers in South Bend, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.