Individual provider Active NPI

David Alan Stacho, LMHC

  • Mental Health Counselor
  • Bradenton, FL
National Provider Identifier
1174713739
Registry record updated Jul 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH 4745 Issued in FL
Practice address
4236 59TH St W
Bradenton, FL 34209-6664
Phone
(941) 962-1216
NPI assigned
Jul 30, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH 4745 FL Primary

Addresses

Primary practice location

4236 59TH St W
Bradenton, FL 34209-6664

Mailing address

4236 59TH St W
Bradenton, FL 34209-6664
Phone (941) 962-1216

Other identifiers 1

IdentifierTypeStateIssuer
Z9751OtherFLBLUECROSS BLUESHIELD PROV

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
MH 4745FLMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185753600000",
    "number": "1174713739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4236 59TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342096664",
            "telephone_number": "941-962-1216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4236 59TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342096664",
            "telephone_number": "941-962-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACHO",
        "first_name": "DAVID",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH 4745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD PROV",
            "identifier": "Z9751",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; 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.