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Deactivated NPI 1740376268 Deactivated / Inactive NPI Female Practitioner

Debra Ann Stack , MA, LP

Psychologist - Cognitive & Behavioral • Minneapolis, MN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Debra Stack has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 04, 2006
NPI Deactivation Date April 24, 2024
Total Practice Duration ~18 Years of Practice (2006 – 2024)

Professional Overview & Biography Verified Profile Summary

Debra Stack, MA, LP was a registered Psychologist - Cognitive & Behavioral practicing in Minneapolis, MN. Throughout an active medical career spanning 18 years, Debra Stack provided care at the practice location at 2124 DUPONT AVENUE SOUTH #104 until profile deactivation on 2024-04-24.

Practice Location & Contact Primary Location

Practice Address

2124 Dupont Avenue South #104

Minneapolis, MN 55403

Telephone 6124811140
Fax 6128790059

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist - Cognitive & Behavioral in Minneapolis, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 24.0 Yrs
State Avg: 30.0 Yrs
Regional Practice Density
10 Specialists

Practicing in Minneapolis, MN (54 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Psychologist - Cognitive & Behavioral Primary Specialty

NUCC Taxonomy Code: 103TB0200X

State License MN LP 3157

A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
NPI 1184828204

Doctor of Philosophy (Ph.D.), Licensed Psychologist

NPI 1356485924

Doctor of Psychology (Psy.D.)

NPI 1467437228

Master of Arts, Licensed Psychologist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
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NPI Profile Deactivated April 24, 2024

Record deactivated on April 24, 2024

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Medical Taxonomy / Specialty Registered (Primary Specialty) March 09, 2024

Psychologist (License #LP3157 in MN)

NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 09, 2007

Registered at 2124 DUPONT AVENUE SOUTH #104, MINNEAPOLIS, MN 55403 (Tel: 6124811140)

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Updated Business Mailing Address July 09, 2007

Registered at 2124 DUPONT AVENUE SOUTH #104, MINNEAPOLIS, MN 55403 (Tel: 6124811140)

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Provider Name / Credentials Updated July 09, 2007

Recorded as DEBRA STACK, M.A.,L.P.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Psychologist (License #LP 3157 in MN)

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Initial NPI Registration & Enumeration October 04, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1740376268
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 04, 2006
Last Update: July 09, 2007
Deactivation Date: April 24, 2024

Mailing Address

2124 Dupont Avenue South #104

Minneapolis, MN 55403

Phone: 6124811140

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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