Healthcare Provider Details

I. General information

NPI: 1033028832
Provider Name (Legal Business Name): AMY STACKLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 LAKELAND TER
JACKSON MS
39216-4702
US

IV. Provider business mailing address

14 CHATHAM PL
CLINTON MS
39056-9654
US

V. Phone/Fax

Practice location:
  • Phone: 443-907-2166
  • Fax:
Mailing address:
  • Phone: 443-907-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMY ELIZABETH STACKLER
Title or Position: MANAGER
Credential: LPC
Phone: 443-907-2166