MARY KAYE TACKER (PHD, LMFT, LADC) – Marriage & Family Therapist, NPI 1629269626
Marriage & Family Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
981 MARRIAGE AND FAMILY THERAPIST in MN
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Provider Addresses for MARY KAYE TACKER (PHD, LMFT, LADC)
Centracare Circle, Shady Oak Mobile Park, St. Cloud, Stearns County, Minnesota, United States
CENTRA CARE HEALTH PLAZA
SAINT CLOUD, MN 563035000
Phone: (320) 229-5199
Fax: (320) 229-5109
Type: Mailing
Saint Cloud Hospital, 1406, 6th Avenue North, St. Cloud, Stearns County, Minnesota, 56303, United States
ST. CLOUD HOSPITAL
ST. CLOUD, MN 563031901
Phone: (320) 251-2700
Fax: (320) 229-5109
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-07-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240723003664 | I | Marriage And Family Therapist | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 56303)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| - | IA | |
| Nurse Practitioner | MN | |
| - | MN | |
| - | MN | |
| Registered Dietitian Or Nutrition Professional | MN | |
| Family Practice | MN | |
| - | MN | |
| - | WI | |
| - | MN |
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