Active NPI
Maxwell Earl Reed Stoltenberg
- Counselor
- Phoenix, AZ
National Provider Identifier
1548731664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LAC-17355
- Practice address
- 4718 N 3Rd Ave
Phoenix, AZ 85013-2705 - Phone
- (928) 853-7109
- NPI assigned
- Dec 16, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | LAC-17355 | AZ | Primary |
Addresses
Primary practice location
4718 N 3Rd Ave
Phoenix, AZ 85013-2705
Mailing address
4718 N 3Rd Ave
Phoenix, AZ 85013-2705
Phone (928) 853-7109
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
| License | State | Type | Specialty |
|---|---|---|---|
| LAC-17355 | AZ | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544918400000",
"number": "1548731664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4718 N 3RD AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850132705",
"telephone_number": "928-853-7109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4718 N 3RD AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850132705",
"telephone_number": "928-853-7109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REED STOLTENBERG",
"first_name": "MAXWELL",
"middle_name": "EARL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-16",
"last_updated": "2018-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AZ",
"license": "LAC-17355",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.