Healthcare Provider Details

I. General information

NPI: 1902185838
Provider Name (Legal Business Name): MELISSA LEE STAHL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 10/08/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E HWY 50 STE 302J
CLERMONT FL
34711-5056
US

IV. Provider business mailing address

1655 E HWY 50 STE 302J
CLERMONT FL
34711-5056
US

V. Phone/Fax

Practice location:
  • Phone: 636-293-2361
  • Fax:
Mailing address:
  • Phone: 636-293-2361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17453
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011009606
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: