Healthcare Provider Details

I. General information

NPI: 1366796260
Provider Name (Legal Business Name): JOHN STITELER MA, LCCT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S KIRKMAN RD #222
ORLANDO FL
32819-7940
US

IV. Provider business mailing address

1513 S KIRKMAN RD #3118
ORLANDO FL
32811-2631
US

V. Phone/Fax

Practice location:
  • Phone: 321-332-6984
  • Fax:
Mailing address:
  • Phone: 321-332-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLCCT 0330020611
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: