MEDICARE: CHARLES JACOB STOCKWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10050-M	NV
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750914792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES JACOB STOCKWELL

Provider Business Mailing Address
First Line	:	2473 BENCH REEF PL
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5202
Country	:	US
Telephone Number	:	702-672-8434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2473 BENCH REEF PL
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5202
Country	:	US
Telephone Number	:	702-672-8434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	06/07/2022

Similar Medicare Providers

1275865362 — MR. GARY CYRAN RPH
Practice Location Address:

1419 E ANDREWS AVE
HENDERSON, NC
27536-5202

Practice Phone: 252-762-0156
Practice Fax: 252-762-0159

1164800355 — FOOD LION, LLC
Practice Location Address:

1419 E ANDREWS AVE
HENDERSON, NC
27536-5202

Practice Phone: 252-762-0156
Practice Fax:

1245698893 — DR. JEREMY TUCKER PHARMD
Practice Location Address:

1419 E ANDREWS AVE
HENDERSON, NC
27536-5202

Practice Phone: 252-433-0553
Practice Fax:

1710505722 — CHRISTOPHER FLYNN II
Practice Location Address:

540 W HORIZON RIDGE PKWY
HENDERSON, NV
89012-5202

Practice Phone: 323-202-9382
Practice Fax:

1811850670 — VEIA INC
Practice Location Address:

2784 BOTTICELLI DR
HENDERSON, NV
89052-3108

Practice Phone: 702-908-4404
Practice Fax:

1558739110 — MAILO K. BRANTNER NP-C
Practice Location Address:

2298 W HORIZON RIDGE PKWY STE 209
HENDERSON, NV
89052-2698

Practice Phone: 702-660-4050
Practice Fax: 702-660-4069

Directions to “ CHARLES JACOB STOCKWELL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.