Active NPI
Stacy Peterson, LCPC
- Professional Counselor
- Great Falls, MT
National Provider Identifier
1992259519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 18900
- Practice address
- 117 Park Dr S Ste a
Great Falls, MT 59401-3612 - Phone
- (406) 781-4973
- Fax
- (406) 403-0222
- NPI assigned
- Aug 11, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 18900 | MT | Primary |
| Mental Health Counselor | 101YM0800X | 18900 | MT | |
| Counselor | 101Y00000X | 18900 | MT |
Addresses
Primary practice location
117 Park Dr S Ste a
Great Falls, MT 59401-3612
Mailing address
PO Box 2851
Great Falls, MT 59403-2851
Phone (406) 781-4973
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 |
|---|---|---|---|
| 18900 | MT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverbend Therapeutics PLLC | Current | Accepting new patients | |
| Renew Wellness Center | Past | Accepting new patients |
Locations
117 Park Dr S
#A
Great Falls, MT 59401
Phone (406) 781-4973
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 and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Great Falls, MT
- NPI 1902560923
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Great Falls, MT
- NPI 1548746456
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644364800000",
"number": "1992259519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2851",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594032851",
"telephone_number": "406-781-4973",
"fax_number": "406-403-0222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 PARK DR S STE A",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594013612",
"telephone_number": "406-781-4973",
"fax_number": "406-403-0222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "STACY",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-11",
"last_updated": "2022-02-09",
"certification_date": "2022-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MT",
"license": "18900",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MT",
"license": "18900",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MT",
"license": "18900",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.