Stacey Burrack Watson, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180006108 Issued in IL

Practice address

415 W Golf Rd Ste 16
Arlington Heights, IL 60005

Phone

(847) 577-0904

Fax

(847) 577-1558

NPI assigned

Mar 22, 2007

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Hope Harbor Autism Support PC

  • Behavior Analyst
  • Arlington Heights, IL
  • NPI 1598589525
  NPD (past)
• Northwest Behavioral Health Services, PC

  • Clinical Psychologist
  • Arlington Heights, IL
  • NPI 1770609315
  NPD (past)

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1972629434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 W GOLF RD STE 16",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600053923",
            "telephone_number": "847-577-0904",
            "fax_number": "847-577-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W GOLF RD STE 16",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "60005",
            "telephone_number": "847-577-0904",
            "fax_number": "847-577-1558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 S Wilke Rd",
            "address_2": "Suite 234",
            "address_purpose": "LOCATION",
            "city": "Arlington Heights",
            "state": "IL",
            "postal_code": "600051533",
            "country_code": "US",
            "telephone_number": "847-577-0904",
            "fax_number": "847-577-1558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "STACEY",
        "middle_name": "BURRACK",
        "name_prefix": "Ms.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180006108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01635186",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheila Warren, APRN, CRNA
• Kathryn Waszak, PT, DPT
• Andrea J Watkins, LCSW
• Christopher Watson, PSYD, ABPP
• James J Watson, H.I.S.
• Virginia Watson, PA-C
• Britni C Watts, PT, DPT
• We Care Orthopedics, LTD.
• Rosemary Weaver, R.D.
• Andrea Jean Wegner

• Professional Counselor in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; 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.