MEDICARE: MS. SUE SHEFFIELD STALCUP M.S.

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	LPC - 10388	AZ

General Provider Information

NPI Number	:	1962495317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE SHEFFIELD STALCUP M.S.

Provider Business Mailing Address
First Line	:	5260 S CASA PRIETO DR
Second Line	:
City	:	GOLD CANYON
State	:	AZ
Zip	:	85218-1891
Country	:	US
Telephone Number	:	480-671-5630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 S HIGLEY RD
Second Line	:	SUITE 112
City	:	MESA
State	:	AZ
Zip	:	85206-3429
Country	:	US
Telephone Number	:	480-654-0992
Fax Number	:	480-325-5444

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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