MEDICARE: MARY J STOKLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LSW4231	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558368175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY J STOKLEY LCSW

Provider Business Mailing Address
First Line	:	122 VILLAGE DR
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-4228
Country	:	US
Telephone Number	:	423-787-0238
Fax Number	:	423-787-0796

Provider Business Practice Location Address
First Line	:	91 JACKSON LN E
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-5300
Country	:	US
Telephone Number	:	423-787-0238
Fax Number	:	423-787-0796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	07/09/2007

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