Staci Lynn Ekblad, LAPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

609-7-15-08A Issued in ND

Practice address

316 2ND Ave W
Williston, ND 58801-5218

Phone

(701) 774-4600

NPI assigned

Jul 15, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Staci Lynn Shumake Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Evolve Therapy and Wellness

  • Mental Health Counselor
  • Williston, ND
  • NPI 1801645866
  NPD Authorized official

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216080000000",
    "number": "1992969323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 2ND AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588015218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 2ND AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588015218",
            "telephone_number": "701-774-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKBLAD",
        "first_name": "STACI",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LAPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-15",
        "last_updated": "2008-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ND",
            "license": "609-7-15-08A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54516",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "SHUMAKE",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carrie Eder, ATC
• Rich L Egeberg, LSW
• Kylie Ehlers, M.S., CF-SLP
• Alaina Eikom
• Angela R Ekblad, NP/RN
• Elite Specialty Clinics, Inc. (Elite Health)
• Elite Specialty Clinics, Inc. (Elite Health & Fitness)
• Terra L Ellingson, LAC, CMHT, CMA
• Marlene Ellis
• Scott Thomas Ellis, DDS

• Mental Health Counselor in Williston, ND
• Providers in Williston, ND by specialty
• Mental Health Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; 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.