MEDICARE: MS. JUDITH O STANSBERRY LPC/MHSP

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	101YP2500X	Professional Counselor	LPC0000000680	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1221702	OTHER	TN	CHA HEALTH
2	359712	OTHER	TN	MHN
3	7679319	OTHER	TN	AETNA
4	270035000	OTHER	TN	MAGELLAN
5	501106	OTHER	TN	VALUE OPTIONS
6	620547289R2	OTHER	TN	JOHN DEERE HERITAGE
7	245446	OTHER	TN	UNITED BEHAVIORAL HEALTH
8	247699	OTHER	TN	COMPSYCH
9	4251971	OTHER	TN	BCBS
10	1065067	OTHER	TN	CIGNA

General Provider Information

NPI Number	:	1770583007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH O STANSBERRY LPC/MHSP

Provider Business Mailing Address
First Line	:	PO BOX 50834
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37950-0834
Country	:	US
Telephone Number	:	865-938-4381
Fax Number	:	865-938-4382

Provider Business Practice Location Address
First Line	:	109 STEKOIA LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-1608
Country	:	US
Telephone Number	:	865-938-4381
Fax Number	:	865-938-4382

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/30/2011

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Directions to “ MS. JUDITH O STANSBERRY LPC/MHSP” Practice Location

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