Glen Howard Stark

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

BBH-LCPC-LIC-79275 Issued in MT

Practice address

20 Cornerstone Way
Bozeman, MT 59718-6004

Phone

(406) 209-8763

NPI assigned

Oct 23, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Manmade Group LLCGroup PAC ID 0941796080, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Manmade Group LLC

  • Mental Health Counselor
  • Bozeman, MT
  • NPI 1619613270
  Medicare reassignment Care Compare group NPD
• Manmade Group LLC

  • Mental Health Counselor
  • Maryville, TN
  • NPI 1356180483
  NPD

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

{
    "created_epoch": "1698019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1083486211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 PEACE PIPE DR",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597151769",
            "telephone_number": "406-579-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 CORNERSTONE WAY",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597186004",
            "telephone_number": "406-209-8763"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1716 W Main St Ste 8C",
            "address_purpose": "LOCATION",
            "city": "Bozeman",
            "state": "MT",
            "postal_code": "597156821",
            "country_code": "US",
            "telephone_number": "406-813-0301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STARK",
        "first_name": "GLEN",
        "middle_name": "HOWARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-23",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MT",
            "license": "BBH-LCPC-LIC-79275",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MT",
            "license": "BBH-LCPC-LIC-79275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline H Stanley, PH.D.
• Jennie Lynn Stanley, MS, NCC, LCPC
• Kelli Stanley, BA, CD, CLC
• Dennis Staples, R. PH.
• Kelsey Stappert, PSYD
• Starlight ABA Mt LLC
• Starlyn Green Inc.
• Stephanie Rona Starr, M.D.
• Natalie Pascutoi Stasi, PA
• Emily Steed, PHARMD

• Professional Counselor in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Professional Counselor in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.