Active NPI
Stephen Christpher Mack, LSAA
- Addiction (Substance Use Disorder) Counselor
- Taos, NM
National Provider Identifier
1871545103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 005761
- Practice address
- 413 Sipapu Rd
Taos, NM 87571 - Phone
- (505) 758-5857
- Fax
- (505) 758-2832
- NPI assigned
- May 16, 2006
- Last updated
- Mar 19, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 005761 | NM | Primary |
Addresses
Primary practice location
413 Sipapu Rd
Taos, NM 87571
Mailing address
7320 Ndcbu
Taos, NM 87571
Phone (505) 751-4536
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 |
|---|---|---|---|
| 005761 | NM | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-County Community Services, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Recovery Care Clinic/Center
- Taos, NM
- NPI 1912995242
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426723200000",
"number": "1871545103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7320 NDCBU",
"city": "TAOS",
"state": "NM",
"postal_code": "87571",
"telephone_number": "505-751-4536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 SIPAPU RD",
"city": "TAOS",
"state": "NM",
"postal_code": "87571",
"telephone_number": "505-758-5857",
"fax_number": "505-758-2832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "STEPHEN",
"middle_name": "CHRISTPHER",
"name_prefix": "Mr.",
"credential": "LSAA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2015-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NM",
"license": "005761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taos, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.