Healthcare Provider Details

I. General information

NPI: 1003426446
Provider Name (Legal Business Name): SARA STAMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4493 WOODBINE RD
PACE FL
32571-8726
US

IV. Provider business mailing address

4823 RED OAK DR
MILTON FL
32583-2767
US

V. Phone/Fax

Practice location:
  • Phone: 850-400-3990
  • Fax:
Mailing address:
  • Phone: 210-980-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25670
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05672
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60776710
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: