Individual
MICHAEL BRYAN STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1513 LAKELAND DR, JACKSON, MS 39216-4829
(769) 777-1000
Mailing address
1606 LAUREL ST, JACKSON, MS 39202-1243
(601) 942-4089
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-25-85361
MS
106S00000X
Behavior Technician
RBT-22-226002
MS
Other
Enumeration date
03/16/2023
Last updated
01/06/2026
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