Provider Demographics
NPI:1225806250
Name:STOCKERT, BRIAN HUGH (MA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HUGH
Last Name:STOCKERT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:HUGH
Other - Last Name:STOCKERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1900 LAKE TAHOE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6305
Mailing Address - Country:US
Mailing Address - Phone:530-573-7970
Mailing Address - Fax:530-578-8922
Practice Address - Street 1:1900 LAKE TAHOE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6305
Practice Address - Country:US
Practice Address - Phone:530-573-7970
Practice Address - Fax:530-578-8922
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor