Mark Tack, LMSW, ADC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

ISW 8702 Issued in FL

Practice address

7424 Apennines Dr
Army Substance Abuse Program (Asap)
Fort Riley, KS 66442-7151

Phone

(785) 239-0662

NPI assigned

Feb 17, 2016

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1184083206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7424 APENNINES DR",
            "address_2": "ARMY SUBSTANCE ABUSE PROGRAM (ASAP)",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "664427151",
            "telephone_number": "785-239-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7424 APENNINES DR",
            "address_2": "ARMY SUBSTANCE ABUSE PROGRAM (ASAP)",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "664427151",
            "telephone_number": "785-239-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACK",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "LMSW, ADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-17",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "KS",
            "license": "9430",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "ISW 8702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED MASTER SOCIAL WORKER",
            "identifier": "9430",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED CLINICAL SOCIAL WORKER INTERN",
            "identifier": "ISW 8702",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trinity Shane Storey, R.D.
• Gerald Rex Stroud Jr., MD
• Keegan Alice Stucker, MS, LCMFT
• Jill K Sump
• Michael W Swann, P.A.C.
• Joel P Taggart
• Regan Tamura, MSW, LCSW
• Nigel Taylor, DPT, PT
• Stephen Uel Taylor, D.O.
• Richard Tekriwala, OTR

• Social Worker in Fort Riley, KS
• Providers in Fort Riley, KS by specialty
• Social Worker in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; 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.