Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Glen Howard Stark

Individual provider Mental Health Counselor · NPI 1083486211

Glen Howard Stark is a Mental Health Counselor in Bozeman, Montana. Qualified in 2023, 3 years ago. Practices with Manmade Group LLC, a 2-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Montana.

Years since qualifying
3
Licensed in
MT
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

20 Cornerstone Way
Bozeman, MT 59718-6004
Phone: (406) 209-8763
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1716 W Main St Ste 8c, Bozeman, MT 59715-6821 — (406) 813-0301

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence BBH-LCPC-LIC-79275 (MT)
Mental Health Counselor Taxonomy 101YM0800X · Licence BBH-LCPC-LIC-79275 (MT)

Record details

NPI number1083486211
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 23, 2023
Last updated in NPPESJune 23, 2025
Certification dateJune 23, 2025
Mailing address361 Peace Pipe Dr, Bozeman, MT 59715-1769

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Manmade Group Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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