Provider Demographics
NPI:1942556279
Name:STAHL, GREG WILLIAM (MHPP)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:WILLIAM
Last Name:STAHL
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W MAIN ST STE C-D
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-2611
Mailing Address - Country:US
Mailing Address - Phone:870-483-0068
Mailing Address - Fax:870-483-0066
Practice Address - Street 1:809 W MAIN ST STE C-D
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-2611
Practice Address - Country:US
Practice Address - Phone:870-483-0068
Practice Address - Fax:870-483-0066
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator