Active NPI
Staussa C Ervin, EDD, LPC
- Mental Health Counselor
- Fort Worth, TX
National Provider Identifier
1992031645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 61666
- Practice address
- 250 W Lancaster Ave Apt 1506
Fort Worth, TX 76102-6360 - Phone
- (817) 462-5057
- Fax
- (817) 462-5057
- NPI assigned
- Oct 29, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 | 61666 | TX | Primary |
Addresses
Primary practice location
250 W Lancaster Ave Apt 1506
Fort Worth, TX 76102-6360
Mailing address
250 W Lancaster Ave Apt 1506
Fort Worth, TX 76102-6360
Phone (817) 462-5057
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61666 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639958400000",
"number": "1992031645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 W LANCASTER AVE APT 1506",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761026360",
"telephone_number": "817-462-5057",
"fax_number": "817-462-5057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 W LANCASTER AVE APT 1506",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761026360",
"telephone_number": "817-462-5057",
"fax_number": "817-462-5057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERVIN",
"first_name": "STAUSSA",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "EDD, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-29",
"last_updated": "2021-12-20",
"certification_date": "2021-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "61666",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.