HEATHER STATHAM (NPI# 1063951416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063951416 |
| Entity Type | Individual |
| Full Name | HEATHER STATHAM |
| Credential | MS, LPC |
| Practice Address |
1465 Lakeland Dr Jackson MS 39216-4719 |
| Practice Telephone | 7697771000 |
| Practice Fax Number | 6019680021 |
| Mailing Telephone | 7697771000 |
| Mailing Fax Number | 6019680021 |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-02-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
2146 | MS | Behavioral Health & Social Service Providers |
| Street Address |
1465 LAKELAND DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003982679 | Dennis Morgan Hydrick Jr. | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2006-11-27 |
| 1629638127 | Kiara Latrese Bass | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2019-06-17 |
| 1427510874 | Stephanie Moses | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2019-04-04 |
| 1184075228 | Janie Mae Grant | Registered Nurse | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2016-06-30 |
| 1225498256 | Arin Adkins | Social Worker | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2016-03-03 |
| 1245616556 | Chrisitan Ware | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-08-10 |
| 1710366273 | Mississippi Children's Home Society | Residential Treatment Facility, Emotionally Disturbed Children | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-05-29 |
| 1952780561 | Laura Moore | Registered Nurse | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-05-28 |
| 1922490853 | Ryan Dunlap | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-03-02 |
| 1265823181 | Brittany Spence | Counselor | 1465 Lakeland Dr, Jackson, MS 39216-4719 | 2015-02-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677893 | Jackson Healing Clinic LLC | Counselor | 2020 Cascade Dr, Jackson, MI 49203-3810 | 2020-10-20 |
| 1568069524 | Philip Ray Nicholas | Counselor | 19 Wood Duck Cv, Jackson, TN 38305-6632 | 2020-10-02 |
| 1184242711 | New Life Goals, LLC | Counselor | 504 Cooper Rd, Jackson, MS 39212-4704 | 2020-07-09 |
| 1548881048 | Gloria Dansby-giles | Counselor | 4500 Interstate 55, North; Suite 220, Jackson, MS 39211 | 2020-05-06 |
| 1962023812 | Kandace Ross | Counselor | 528 Woodbury Rd, Jackson, MS 39206-4830 | 2020-05-01 |
| 1629600945 | Modern Hope of Ms,llc | Counselor | 5825 Kings Pl, Jackson, MS 39211-3321 | 2020-02-05 |
| 1003447657 | Chandler & Associates, LLC | Counselor | 1900 Dunbarton Dr Ste G, Jackson, MS 39216-5015 | 2020-02-03 |
| 1659910701 | Laura E Rutledge | Counselor | 1437 Old Square Rd Ste 101, Jackson, MS 39211-5533 | 2020-01-06 |
| 1154960961 | Timothy A Norris | Counselor | 5026 Raintree Dr, Jackson, MS 39272-5753 | 2019-12-26 |
| 1982243838 | Paula Jane Blocker | Counselor | 401 West St Ste 117, Jackson, MN 56143-1219 | 2019-12-24 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.