Individual provider Active NPI

Kylie A Stark

  • Professional Counselor
  • Dickinson, ND
National Provider Identifier
1922760776
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
1211-7-1-22 Issued in ND
Practice address
1463 I94 Business Loop E
Dickinson, ND 58601-6434
Phone
(701) 227-7506
NPI assigned
Oct 8, 2021
Last updated
Jul 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 1211-7-1-22 ND Primary
Specialist 174400000X NU
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

1463 I94 Business Loop E
Dickinson, ND 58601-6434

Mailing address

1463 I94 Business Loop E
Dickinson, ND 58601-6434
Phone (701) 227-7506

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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

Enrollment IDStateProvider typePAC IDDetails
I20241223003153 ND Practitioner - Mental Health Counselor 4284161621 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Badlands Human Service CenterGroup PAC ID 9739085499, 18 clinicians

Practice addresses (Care Compare)

1463 I94 Business Loop E
Dickinson, ND 58601-6434
Phone (701) 227-7500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Badlands Behavioral Health Clinic CurrentSince Oct 7, 2024 Accepting new patients
Badlands Behavioral Health Clinic PastSince Oct 10, 2021 Accepting new patients

Locations

600 E Boulevard Ave
Dept 325
Bismarck, ND 58505
Phone (701) 328-4644

1463 I94 Business Loop E
Dickinson, ND 58601
Phone (701) 227-7500

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1922760776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1463 I94 BUSINESS LOOP E",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586016434",
            "telephone_number": "701-227-7506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1463 I94 BUSINESS LOOP E",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586016434",
            "telephone_number": "701-227-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "KYLIE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-08",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ND",
            "license": "1211-7-1-22",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dickinson, ND

Sources for this page

Verify at the official NPI Registry.