Theresa Dawn Stack, LMSW
NPI 1427251909ActiveIndividual· Social Worker, Clinical· Traverse City, MI
Social Worker, Clinical (LMSW) with Old Town Psychological Services, practicing in Traverse City, Michigan. Medicare paid $12,450 for services to 15 patients in 2024.
Overview
| NPI | 1427251909 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LMSW |
| Sole proprietor | Yes |
| NPI issued | Jun 11, 2007 |
| Last updated in NPPES | Jul 8, 2007 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | 6801019505 | MI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (MI) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 15 |
|---|---|
| Services billed | 199 across 6 procedure codes |
| Paid by Medicare | $12,450 |
Education and affiliations
| Graduation year | 1997 |
|---|---|
| Medicare specialty | Clinical Social Worker |
| Telehealth | Offers telehealth |
Medical group
- Old Town Psychological ServicesTraverse City, MI · 8 clinicians
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