Active NPI
Matthew Michael Stanley, LPC
- Counseling Psychologist
- Lake Wales, FL
National Provider Identifier
1699250357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 6401016859
- Practice address
- 548 Bell Prairie Cir
Lake Wales, FL 33859-2115 - Phone
- (312) 505-4798
- NPI assigned
- Sep 28, 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 6401016859 | MI | Primary |
Addresses
Primary practice location
548 Bell Prairie Cir
Lake Wales, FL 33859-2115
Mailing address
548 Bell Prairie Cir
Lake Wales, FL 33859-2115
Phone (312) 505-4798
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 |
|---|---|---|---|
| 6401016859 | MI | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726704000000",
"number": "1699250357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "548 BELL PRAIRIE CIR",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338592115",
"telephone_number": "312-505-4798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "548 BELL PRAIRIE CIR",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338592115",
"telephone_number": "312-505-4798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "MATTHEW",
"middle_name": "MICHAEL",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-09-28",
"last_updated": "2024-09-19",
"certification_date": "2024-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "6401016859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Wales, FL
- Shelly Kay Spencer, M.A. CCC-SLP
- Claudia Spiker
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- Matthew William Sprunt, PA-C
- SS Polk II Community HC LLC
- Jennifer Michele Steele, APRN
- Floyd Allen Stern, MD
- La Kenya Delon Stone, CNA
- Cynthia Christine Strazzulla, MS-CCC, SLP
- Kaycie Samantha Stringer, ARNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.