Individual provider Active NPI

Victoria M. Stavlas, LPCC,LSW

  • Mental Health Counselor
  • Westlake, OH
National Provider Identifier
1174669402
Registry record updated Jul 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
E.0003190 Issued in OH
Practice address
30400 Detroit Rd
Suite 301
Westlake, OH 44145-1872
Phone
(440) 376-2844
Fax
(440) 250-8864
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X E.0003190 OH Primary
Social Worker 104100000X S0006779 OH

Addresses

Primary practice location

30400 Detroit Rd
Suite 301
Westlake, OH 44145-1872

Mailing address

30400 Detroit Rd
Suite 301
Westlake, OH 44145-1872
Phone (440) 376-2844

Other identifiers 1

IdentifierTypeStateIssuer
0308483MedicaidOH

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
E.0003190OHMDMental Health Counselor
S0006779OHMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311552000000",
    "number": "1174669402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30400 DETROIT RD",
            "address_2": "SUITE 301",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451872",
            "telephone_number": "440-376-2844",
            "fax_number": "440-250-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30400 DETROIT RD",
            "address_2": "SUITE 301",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451872",
            "telephone_number": "440-376-2844",
            "fax_number": "440-250-8864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAVLAS",
        "first_name": "VICTORIA",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "LPCC,LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2011-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.0003190",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S0006779",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0308483",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westlake, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; 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.