Active NPI
Christopher L Stack, M.A./DOCTORAL STUDEN
- Mental Health Counselor
- Walbridge, OH
National Provider Identifier
1932480415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- C.0700856
- Practice address
- 5693 Blue Grass Dr
Walbridge, OH 43465-1148 - Phone
- (419) 838-7626
- NPI assigned
- Aug 29, 2011
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C.0700856 | OH | Primary |
Addresses
Primary practice location
5693 Blue Grass Dr
Walbridge, OH 43465-1148
Mailing address
5693 Blue Grass Dr
Walbridge, OH 43465-1148
Phone (419) 838-7626
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C.0700856 | OH | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314576000000",
"number": "1932480415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5693 BLUE GRASS DR",
"city": "WALBRIDGE",
"state": "OH",
"postal_code": "434651148",
"telephone_number": "419-838-7626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5693 BLUE GRASS DR",
"city": "WALBRIDGE",
"state": "OH",
"postal_code": "434651148",
"telephone_number": "419-838-7626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACK",
"first_name": "CHRISTOPHER",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "M.A./DOCTORAL STUDEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-29",
"last_updated": "2011-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "C.0700856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walbridge, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.