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TYLER STACY LPC
NPI 1376082719
Counselor - Professional in Jackson, MS

Active since February 17, 2017Opted out of Medicare · through Jul 3, 2028
4500 I 55 N STE 208, JACKSON, MS 39211(601) 405-7440 Get Directions Write a Review

NPPES record last updated: March 19, 2019. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Mar 19, 2019, Feb 17, 2017 (2 updates tracked since 2017).

About Tyler Stacy Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYLER STACY LPC (NPI 1376082719) is an individual professional provider in Jackson, Mississippi, licensed in Mississippi (2366) and active in the NPI registry since February 2017. He has opted out of Medicare through July 3, 2028 and maintains a secondary practice location in Monroe.

NPPES Registry Identity

NPI1376082719
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameTYLER STACYCredential: LPC
Location Address4500 I 55 N STE 208Jackson, MS 39211-5931
Mailing Address4500 I 55 N Ste 208Jackson, MS 39211-5931 · (601) 405-7440
Phone(601) 405-7440
Sole ProprietorYes
Enumeration DateFebruary 17, 2017
Last NPPES UpdateMarch 19, 20192 updates tracked since enumeration
✔ NPI 1376082719 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MS · 2366
Also ListedCounselorTaxonomy 101Y00000X · License 6721 (LA)
4500 I 55 N STE 208, Jackson, MS 39211
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Secondary Practice Location 1

Location 1622 Riverside DrMonroe, LA 71201-6211 · Phone (601) 317-4517

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Tyler Stacy Lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 3, 2024 through July 3, 2028.

Opt-Out Effective DateJuly 3, 2024
Opt-Out In Effect ThroughJuly 3, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MINDFUL SOLUTIONS, LLC
Counselor (Professional)
4500 I 55 N STE 208
JACKSON, MS 39211
Hinds County (601) 292-6260
CARROLL D. BLACKLEDGE MA, P-LPC
Counselor (Professional)
4500 I 55 N STE 208
JACKSON, MS 39211
Hinds County (601) 405-7440

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tyler Stacy's NPI number?

The NPI number for Tyler Stacy is 1376082719. It was assigned to this individual provider in the NPPES registry on February 17, 2017.

Where is Tyler Stacy located?

Tyler Stacy practices at 4500 I 55 N Ste 208, Jackson, MS 39211. The listed phone number is (601) 405-7440.

What is Tyler Stacy's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Tyler Stacy enrolled in Medicare?

No. Tyler Stacy has opted out of Medicare through July 3, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Tyler Stacy was last updated on March 19, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.