Provider Demographics
NPI:1174998504
Name:STANA, KARLY
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:STANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-2913
Mailing Address - Country:US
Mailing Address - Phone:330-770-0515
Mailing Address - Fax:
Practice Address - Street 1:8170 SOUTH AVE STE 7
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6434
Practice Address - Country:US
Practice Address - Phone:724-730-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-22-62201103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1-22-62201OtherBEHAVIOR ANALYST
OH01347OtherCERTIFIED OHIO BEHAVIOR ANALYST
OH0037606Medicaid