Healthcare Provider Details

I. General information

NPI: 1043967474
Provider Name (Legal Business Name): KATHY STOECKER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2022
Last Update Date: 03/05/2022
Certification Date: 03/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 N SUMMIT AVE
PRESCOTT AZ
86301-2712
US

IV. Provider business mailing address

2296 GOLF CLUB LN
PRESCOTT AZ
86303-6922
US

V. Phone/Fax

Practice location:
  • Phone: 928-458-1227
  • Fax: 928-379-5111
Mailing address:
  • Phone: 928-899-7854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK HOWARD STOECKER
Title or Position: COO
Credential: MD
Phone: 928-899-7854