Active NPI
Samuel Staggs, M.ED
- Mental Health Counselor
- Covington, KY
National Provider Identifier
1982974630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 164155
- Practice address
- 513 Madison Ave
Covington, KY 41011-1562 - Phone
- (859) 331-3292
- Fax
- (859) 578-2864
- NPI assigned
- Jan 11, 2012
- Last updated
- Aug 10, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 164155 | KY | Primary |
Addresses
Primary practice location
513 Madison Ave
Covington, KY 41011-1562
Mailing address
502 Farrell Dr
Covington, KY 41011-3717
Phone (859) 578-3204
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 610661458 | Other | KY | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164155 | KY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470787200000",
"number": "1982974630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "502 FARRELL DR",
"city": "COVINGTON",
"state": "KY",
"postal_code": "410113717",
"telephone_number": "859-578-3204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "513 MADISON AVE",
"city": "COVINGTON",
"state": "KY",
"postal_code": "410111562",
"telephone_number": "859-331-3292",
"fax_number": "859-578-2864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAGGS",
"first_name": "SAMUEL",
"credential": "M.ED",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-01-11",
"last_updated": "2016-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "KY",
"license": "164155",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "610661458",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Covington, KY
- St. Elizabeth Healthcare
- St. Elizabeth Medical Center
- St. Elizabeth Medical Center, Inc.
- St. Elizabeth Medical Center, Inc.
- Edwin Paul Staat, APRN
- Tiara Stamper, CPSS
- Elliott Dean Stanley, D.O.
- Anna Stark, LCSW
- Starting Point of Kentucky, PSC (Crossroads Treatment Center Covington)
- Ceanna Stephenson, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.