Active NPI
Michael Bryan Stack
- Behavior Analyst
- Jackson, MS
National Provider Identifier
1013618065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-25-85361
- Practice address
- 1513 Lakeland Dr
Jackson, MS 39216-4829 - Phone
- (769) 777-1000
- NPI assigned
- Mar 16, 2023
- Last updated
- Jan 6, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-25-85361 | MS | Primary |
| Behavior Technician | 106S00000X | RBT-22-226002 | MS |
Addresses
Primary practice location
1513 Lakeland Dr
Jackson, MS 39216-4829
Mailing address
1606 Laurel St
Jackson, MS 39202-1243
Phone (601) 942-4089
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 |
|---|---|---|---|
| RBT-22-226002 | MS | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1767657600000",
"number": "1013618065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1606 LAUREL ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392021243",
"telephone_number": "601-942-4089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1513 LAKELAND DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164829",
"telephone_number": "769-777-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACK",
"first_name": "MICHAEL",
"middle_name": "BRYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-16",
"last_updated": "2026-01-06",
"certification_date": "2026-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MS",
"license": "1-25-85361",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MS",
"license": "RBT-22-226002",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
- St. Dominic Medical Associates LLC (St. Dominic Gastroenterology)
- St. Dominic Medical Associates, LLC
- St. Dominic-Jackson Memorial Hospital
- Mariah St.Clair
- Sta-Home Hospice
- Jason Dean Stacy, M.D.
- Tyler Stacy, LPC
- Staffing Innovations Inc.
- Beverly Fulgham Stafford, CRNA
- Abigail Kathleen Stallings, DO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.