Individual provider Active NPI

Richard S Stein, LPCC-S

  • Professional Counselor
  • Canton, OH
National Provider Identifier
1063801553
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E.1800691-SUPV Issued in OH
Practice address
4200 Munson St NW
Suite a
Canton, OH 44718-2981
Phone
(330) 915-2907
Fax
(330) 915-2958
NPI assigned
Jan 21, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LICDC.162249 OH
Professional Counselor 101YP2500X E.1800691-SUPV OH Primary

Addresses

Primary practice location

4200 Munson St NW
Suite a
Canton, OH 44718-2981

Mailing address

4200 Munson St NW
Suite a
Canton, OH 44718-2981
Phone (330) 915-2907

Other practice location 1

1207 W State St Ste M
Alliance, OH 44601
Phone (330) 821-8407

Other identifiers 1

IdentifierTypeStateIssuer
0273544MedicaidOH

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

LicenseStateTypeSpecialty
LICDC.162249OHMDAddiction (Substance Use Disorder) Counselor
E.1800691-SUPVOHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Wellness Grove, LLC Addiction (Substance Use Disorder) CurrentSince Oct 16, 2022 Accepting new patients
Wellness Grove LLC Addiction (Substance Use Disorder) PastSince Jul 21, 2024 Accepting new patients

Locations

4200 Munson St NW
Ste A
Canton, OH 44718
Phone (330) 915-2907

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1063801553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 MUNSON ST NW",
            "address_2": "SUITE A",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182981",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 MUNSON ST NW",
            "address_2": "SUITE A",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182981",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1207 W State St Ste M",
            "address_purpose": "LOCATION",
            "city": "Alliance",
            "state": "OH",
            "postal_code": "44601",
            "country_code": "US",
            "telephone_number": "330-821-8407",
            "fax_number": "330-821-8506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEIN",
        "first_name": "RICHARD",
        "middle_name": "S",
        "credential": "LPCC-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-21",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.162249",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1800691-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0273544",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.