Stacie Michelle Young, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178.017411 Issued in IL

Practice address

4835 Manhattan Dr
Rockford, IL 61108-2265

Phone

(815) 520-2303

NPI assigned

Jun 6, 2022

Sex

Female

Sole proprietor

No

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 IL

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, 2020

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Willow Creek Counseling LLCGroup PAC ID 8325415102, 9 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 and National Provider Directory roles.

• Willow Creek Counseling LLC

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1144941394

  Professional

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1912636929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2968 BE VER VUE RD",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610088081",
            "telephone_number": "847-917-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 MANHATTAN DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082265",
            "telephone_number": "815-520-2303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "STACIE",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.017411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Elizabeth Yost, MS ED, ATC
• Amy Lynn Young, FNP-BC
• Caleb A Young, MPT
• Elizabeth Dorothy Young
• Melissa Noel Young, PSY.D.
• Uthman Mohammad Younis, MD
• Angie Youssef Hernandez, DPM
• Youth Service Bureau of Illinois Valley
• Youth Services Network
• Youth Services Network

• Professional Counselor in Rockford, IL
• Providers in Rockford, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.