Active NPI
Christopher Stack, PSY.D.
- Psychologist
- Coalinga, CA
National Provider Identifier
1396242855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 24511 W Jayne Ave
Coalinga, CA 93210-9503 - Phone
- (559) 934-3075
- NPI assigned
- Apr 11, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
24511 W Jayne Ave
Coalinga, CA 93210-9503
Mailing address
24511 W Jayne Ave
Coalinga, CA 93210-9503
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31864 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523404800000",
"number": "1396242855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24511 W JAYNE AVE",
"city": "COALINGA",
"state": "CA",
"postal_code": "932109503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24511 W JAYNE AVE",
"city": "COALINGA",
"state": "CA",
"postal_code": "932109503",
"telephone_number": "559-934-3075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACK",
"first_name": "CHRISTOPHER",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-11",
"last_updated": "2018-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coalinga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.