Active NPI
Diane Jean Stark, MSSW LCSW
- Mental Health Counselor
- Brentwood, TN
National Provider Identifier
1780712943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 746
- Practice address
- 5034 Thoroughbred LN Ste D
Brentwood, TN 37027-4231 - Phone
- (615) 507-2082
- Fax
- (615) 507-2085
- NPI assigned
- Mar 1, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 746 | TN | Primary |
Addresses
Primary practice location
5034 Thoroughbred LN Ste D
Brentwood, TN 37027-4231
Mailing address
5034 Thoroughbred LN Ste D
Brentwood, TN 37027-4231
Phone (615) 507-2082
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0122302 | Other | TN | BLUE CROSS BLUE SHIELD |
| 1105848 | Other | TN | CIGNA BEHAVIORAL HEALTH |
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 |
|---|---|---|---|
| 746 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192233600000",
"number": "1780712943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5034 THOROUGHBRED LN STE D",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370274231",
"telephone_number": "615-507-2082",
"fax_number": "615-507-2085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5034 THOROUGHBRED LN STE D",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370274231",
"telephone_number": "615-507-2082",
"fax_number": "615-507-2085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "DIANE",
"middle_name": "JEAN",
"credential": "MSSW LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2007-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TN",
"license": "746",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0122302",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA BEHAVIORAL HEALTH",
"identifier": "1105848",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.