| Doctor Name: | MR. JOHN M STALKER |
| NPI Number: | 1427489624 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S. |
| License Number: | 2013041569 |
| Business Practice Address: | 130 Calo Ln Lake Ozark, MO - 650499208 |
| Business Phone Number: | 5733652221 |
| Business Fax Number: | 5733652224 |
| Mailing Address: | 130 Calo Ln, LAKE OZARK |
| State: | MO |
| Postal Code: | 650499208 |
| Phone Number: | 5733652221 |
| Fax Number: | 5733652224 |
| NPI Enumeration Date: | 12/12/2013 |
| NPI Last Update Date: | 04/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2013041569 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |