MRS. MICHELLE LOIS STACKHOUSE (NPI# 1396229027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396229027 |
| Entity Type | Individual |
| Full Name | MRS. MICHELLE LOIS STACKHOUSE |
| Other Name | MRS. MICHELLE LOIS BEYER |
| Credential | PEER SUPPORT |
| Practice Address |
5736 East Blvd Nw Canton OH 44718-1655 |
| Practice Telephone | 3308061953 |
| Mailing Telephone | 3308061953 |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2018-09-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 00030 | OH | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | ICAN, INC. | 34-1575839 | 01 |
| Street Address |
5736 EAST BLVD NW |
| City | CANTON |
| State | OH |
| Zip Code | 44718-1655 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639658057 | Christine Lynn Mccrone | Psychologist | 4450 Belden Village St Nw Ste 701, Canton, OH 44718 | 2018-08-07 |
| 1295252500 | Dora C Holliday | Student in an Organized Health Care Education/Training Program | 4641 Fulton Dr N.w., Canton, OH 44718 | 2017-08-28 |
| 1770035487 | A B A Let's Play, Inc. | Community/Behavioral Health | 6304 Shipslanding Ave Nw, Canton, OH 44718 | 2016-10-28 |
| 1457710139 | Aria Lg Counseling and Wellness Center, LLC | Clinic/Center | 5262 Fulton Road Nw, Canton, OH 44718 | 2016-02-23 |
| 1457722365 | Melinda R Bond | Nurse Practitioner | 4105 Holiday Street Nw, Canton, OH 44718 | 2015-10-19 |
| 1164804860 | Ashley Marie Whetsell | Dentist | 4550 Belden Village Street Nw, Canton, OH 44718 | 2015-06-18 |
| 1346643749 | Emil D. Poporad, Dds | Dentist | 4124 Fulton Rd. N.w., Suite 102, Canton, OH 44718 | 2014-09-30 |
| 1699198390 | Lauri Sanders | Social Worker | 5860 Fulton Dr Nw, Canton, OH 44718 | 2014-01-31 |
| 1376893768 | Courteney R Briceland | Social Worker | 4641 Fulton Rd. Nw, Canton, OH 44718 | 2012-09-13 |
| 1982953220 | Lyudmyla Z Rockaway | Marriage & Family Therapist | 4895 Dressler Road Nw, Ste A, Canton, OH 44718 | 2012-08-31 |
| Find all providers in zip 44718 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093350068 | Marc A Walker | Peer Specialist | 3311 12th St Nw, Canton, OH 44708-3909 | 2019-11-13 |
| 1114569506 | Nicole Herndon | Peer Specialist | 1114 Gonder Ave Se, Canton, OH 44707-3300 | 2019-10-17 |
| 1588138390 | Angela Rhoad | Peer Specialist | Coleman Professional Services 400 Tuscarawas St W., Canton, OH 44702 | 2019-01-15 |
| 1851864144 | Jennifer Kathleen Shannon | Peer Specialist | 2945 Willowrow Ave Ne, Canton, OH 44705-3612 | 2019-01-09 |
| 1861962599 | Darnella L Jenkins | Peer Specialist | 2306 Crown Pl Nw, Canton, OH 44708-4420 | 2018-11-26 |
| 1922520865 | Marc Slotnick | Peer Specialist | 43825 Michigan Ave., Canton, MI 48188 | 2017-07-12 |
| 1427656354 | Aaron Schreffler | Peer Specialist | 401 Tuscarawas St W Ste 501, Canton, OH 44702-2045 | 2020-10-13 |
| 1659985158 | Tracy Hart | Peer Specialist | 80 State Highway 310 Ste 1, Canton, NY 13617-1493 | 2020-09-02 |
| 1790309581 | Jamaine Thomas Atkins Sr. | Peer Specialist | 50430 School House Rd, Canton, MI 48187-5910 | 2020-06-08 |
| 1093338154 | Elvis Mcgrath | Peer Specialist | 1920 Schneider St Ne, Canton, OH 44721-3352 | 2020-05-24 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.