MS. STACY RIDDLE-MATTOX (NPI# 1629348396) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629348396 |
| Entity Type | Individual |
| Full Name | MS. STACY RIDDLE-MATTOX |
| Credential | MS |
| Practice Address |
2725 Highway 51 South Hernando MS 38632 |
| Mailing Address |
P.o. Box 839 303 North Madison Street Corinth MS 38835-0839 |
| Practice Telephone | 6624491808 |
| Practice Fax Number | 6624491811 |
| Mailing Telephone | 6622869883 |
| Mailing Fax Number | 6622849836 |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2015-11-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
MS | Behavioral Health & Social Service Providers | |
| Y | 101YP2500X |
Counselor Specialization: Professional |
MS | Behavioral Health & Social Service Providers | |
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers |
| Street Address |
2725 HIGHWAY 51 SOUTH |
| City | HERNANDO |
| State | MS |
| Zip Code | 38632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316460017 | Tanya Redmond | Case Manager/Care Coordinator | 2725 Highway 51 South, Hernando, MS 38632 | 2017-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275042335 | Dominic Lashay Freeman | Case Management | 2744 Hwy 51 South, Hernando, MS 38632 | 2017-09-21 |
| 1851814875 | Staci Lea Hudson | Nurse Practitioner | 2705 Hwy 51 South, Hernando, MS 38632 | 2017-07-21 |
| 1629425517 | Jamieka Harris | Counselor | 2705 Hwy 51 S, Hernando, MS 38632 | 2016-05-20 |
| 1215302476 | Elizabeth Claire Corban | Counselor | 2725 Highway 51 S., Hernando, MS 38632 | 2015-12-14 |
| 1669850004 | Jcc, LLC | Dentist | 1150 Monteith Avenue, Suite 102, Hernando, MS 38632 | 2015-05-18 |
| 1053701995 | Leigh Houston | Registered Nurse | 3104 Stonehenge Dr, Hernando, MS 38632 | 2015-01-30 |
| 1871831552 | Hernando Dental Group Incorporated | Dentist | 2264 Mcingvale Rd., Hernando, MS 38632 | 2013-01-30 |
| 1255677001 | Midsouth Medical Specialties, LLC | Pharmacy | 2260 Highway 515 South, Hernando, MS 38632 | 2012-12-26 |
| 1447506514 | Surgical First Assist, LLC | Specialist/Technologist, Other | 8921 Black Panther Cove, Herenando, MS 38632 | 2012-07-26 |
| 1629252093 | Debra Shelton | Counselor | 190 W South St, Hernando, MS 38632 | 2007-12-20 |
| Find all providers in zip 38632 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174828933 | Erin Boswell Rogers | Counselor | 1775 Memphis St, Hernando, MS 38632-1703 | 2011-01-25 |
| 1790045391 | Sommer Anne Tubbs | Counselor | 2725 Highway 51 S, Hernando, MS 38632-2634 | 2012-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750478 | Latibbie Cavett | Counselor | 1311 Rosemont Dr, Clinton, MS 39056-3954 | 2020-11-05 |
| 1306445309 | Teresa Nicole Worthy | Counselor | 6690 Rose Ln # B, Marion, MS 39342-9201 | 2020-10-21 |
| 1841899978 | Kbccms, LLC | Counselor | 1501 Jackson Ave W Ste 113, Oxford, MS 38655-2566 | 2020-10-20 |
| 1053910281 | Julie Magee Powell | Counselor | 121 Sweetgum Rd N, Brandon, MS 39047-6235 | 2020-10-19 |
| 1245838143 | Liria Peshkepia | Counselor | 1105 W Jackson St, Tupelo, MS 38804-2515 | 2020-10-13 |
| 1346847837 | Connection Counseling | Counselor | 336 N Green St, Tupelo, MS 38804-3828 | 2020-10-07 |
| 1609480086 | Robin Melissa Aucoin | Counselor | 1745 County Road 344, Quitman, MS 39355-9454 | 2020-09-03 |
| 1619589538 | Pamela Peoples | Counselor | 1888 Main St Ste C-189, Madison, MS 39110-6337 | 2020-08-21 |
| 1194334656 | Shania Barr | Counselor | 33 Bedford Forrest Ln, Hattiesburg, MS 39401-9186 | 2020-07-29 |
| 1609485515 | Charleen Brown Sproles | Counselor | 434 Katherine Dr Ste B, Flowood, MS 39232-8811 | 2020-07-27 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MS. STACY RIDDLE-MATTOX.
| 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.