| Glen Howard Stark, | |
|
20 Cornerstone Way, Bozeman, MT 59718-6004 | |
| (406) 209-8763 | |
| Not Available |
| Full Name | Glen Howard Stark |
|---|---|
| Gender | Male |
| Speciality | Mental Health Counselor |
| Experience | 3 Years |
| Location | 20 Cornerstone Way, Bozeman, Montana |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083486211 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | BBH-LCPC-LIC-79275 (Montana) | Secondary |
| 101YP2500X | Counselor - Professional | BBH-LCPC-LIC-79275 (Montana) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Manmade Group Llc | 0941796080 | 2 |
| Entity Name | Manmade Group LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1619613270 PECOS PAC ID: 0941796080 Enrollment ID: O20251229001442 |
| Mailing Address | Practice Location Address |
|---|---|
| Glen Howard Stark, 361 Peace Pipe Dr, Bozeman, MT 59715-1769 Ph: (406) 579-4255 | Glen Howard Stark, 20 Cornerstone Way, Bozeman, MT 59718-6004 Ph: (406) 209-8763 |
Tara Barrett, PCLC Counselor Medicare: Not Enrolled in Medicare Practice Location: 2417 W Main St Ste 2, Bozeman, MT 59718 Phone: 406-600-4297 |
Danielle Schacter, MS, LCPC Counselor Medicare: Accepting Medicare Assignments Practice Location: 2417 W Main St Ste 2, Bozeman, MT 59718 Phone: 406-600-4297 |
Kathleen Byrne, MA, PCLC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1924 W Stevens St Ste 202, Bozeman, MT 59718 Phone: 065-953-7464 Fax: 406-578-1363 |
Eva L Ticknor, PCLC Counselor Medicare: Not Enrolled in Medicare Practice Location: 950 Stoneridge Dr Ste 1, Bozeman, MT 59718 Phone: 406-624-6007 |
Paula Mills, LCPC Counselor Medicare: Accepting Medicare Assignments Practice Location: 716 S 20th Ave, Suite 201, Bozeman, MT 59718 Phone: 406-522-0511 |
Megan Spalding, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 771 Rosa Way Unit A, Bozeman, MT 59718 Phone: 406-599-7583 |
Laura Mayonne Dumka, Counselor Medicare: Not Enrolled in Medicare Practice Location: 2002 N 22nd Ave Ste 1, Bozeman, MT 59718 Phone: 406-579-4984 |