Healthcare Provider Details

I. General information

NPI: 1124200845
Provider Name (Legal Business Name): SUSAN ALLEENE STOEFFLER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 MAIN ST STE 203
PLACERVILLE CA
95667-5698
US

IV. Provider business mailing address

312 MAIN ST STE 203
PLACERVILLE CA
95667-5698
US

V. Phone/Fax

Practice location:
  • Phone: 530-303-8011
  • Fax: 530-237-1552
Mailing address:
  • Phone: 530-303-8011
  • Fax: 530-237-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: