Krystal Nicodemus, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

85621 Issued in TX

Practice address

777 International Pkwy Ste 260
Flower Mound, TX 75022-5303

Phone

(972) 221-7900

NPI assigned

Sep 27, 2022

Last updated

Mar 14, 2024By the provider in NPPES

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

Other names 1

• Krystal Nicodemus Former name

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: krystal.nicodemus.1@25899.direct.athenahealth.com

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.

• BSW Geode Clinicians of Texas PLLC

  dba Geode Health 2

  • Psychiatry Physician
  • Allen, TX
  • NPI 1790482834
  Medicare reassignment NPD
• Geode Health of Texas, PLLC

  • Psychiatry Physician
  • Allen, TX
  • NPI 1851037162
  Medicare reassignment NPD
• Mentality PLLC

  • Community/Behavioral Health Agency
  • Fairview, TX
  • NPI 1629963855
  NPD Authorized official
• Sereneco Wellness

  • Professional Counselor
  • Frisco, TX
  • NPI 1841818879
  NPD
• Sereneco Wellness Center LLC

  • Mental Health Counselor
  • Frisco, TX
  • NPI 1932829041
  NPD

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

{
    "created_epoch": "1664236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1952025587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 AVON LN STE 190B",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750331549",
            "telephone_number": "972-259-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 INTERNATIONAL PKWY STE 260",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750225303",
            "telephone_number": "972-221-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICODEMUS",
        "first_name": "KRYSTAL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-27",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "85621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "NICODEMUS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mery Linh Nguyen
• Vivi Nguyen, PHARMD
• Desiree Ngwanah
• Christina Trang Ni, PA
• Dianna Nickel, LPC
• Raazia Nihan
• Behrooz Niknam, D.D.S.
• Daniela Nirdlinger, OTR
• Nis Medical Associates, PLLC
• Nix Family Chiropractic

• Mental Health Counselor in Flower Mound, TX
• Providers in Flower Mound, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.