Marc Pavlack, PRS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

APS.002165 Issued in OH

Practice address

282 Stelton Rd
Xenia, OH 45385-5220

Phone

(937) 303-8239

NPI assigned

May 24, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Her Story, Inc

  • Addiction (Substance Use Disorder) Counselor
  • Springfield, OH
  • NPI 1164194478

  Case Manager/Care Coordinator

  NPD
• Her Story, Inc

  • Community/Behavioral Health Agency
  • Springfield, OH
  • NPI 1841901337
  NPD
• Access Counseling Services LLC

  • Community/Behavioral Health Agency
  • Middletown, OH
  • NPI 1073884524
  NPD (past)
• Access Counseling Services, LLC

  • Community/Behavioral Health Agency
  • Middletown, OH
  • NPI 1245583673
  NPD (past)
• Decoach Team LLC

  dba DeCoach Rehabilitation Centre

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cincinnati, OH
  • NPI 1366992224
  NPD (past)
• Decoach Team LLC

  dba DeCoach Rehabilitation Centre

  • Adult Mental Health Clinic/Center
  • Cincinnati, OH
  • NPI 1578037552
  NPD (past)

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1659946440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 212",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453850212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "282 STELTON RD",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453855220",
            "telephone_number": "937-303-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVLACK",
        "first_name": "MARC",
        "credential": "PRS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-24",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "APS.002165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kishan Dhiren Patel, DDS
• Rajendra A Patel, MD
• Somashekhar S Patil, MD
• Dustin Patterson
• Morgan E Paul
• Ronnell Payne
• Gary Penn
• James Patrick Pennington, RPH
• Johsua Penny
• Julie Kay Perdue, PHARMD, RPH

• Peer Specialist in Xenia, OH
• Providers in Xenia, OH by specialty
• Peer Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.