Patrick Charles Stack, D.MIN

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

2775 Issued in MO

Practice address

10702 Manchester Rd
Kirkwood, MO 63122-1321

Phone

(314) 966-1022

Fax

(314) 968-7126

NPI assigned

May 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1407062383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 VILLAWOOD LN",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631194916",
            "telephone_number": "314-963-1962",
            "fax_number": "314-968-7126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10702 MANCHESTER RD",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "631221321",
            "telephone_number": "314-966-1022",
            "fax_number": "314-968-7126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "PATRICK",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.MIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-15",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MO",
            "license": "2775",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "000122",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MO",
            "license": "300107",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Kirkwood, MO
• Providers in Kirkwood, MO by specialty
• Addiction (Substance Use Disorder) Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.