Healthcare Provider Details

I. General information

NPI: 1104229731
Provider Name (Legal Business Name): MARLA STAMM MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N PLAZA EAST BLVD STE 106
EVANSVILLE IN
47715-2804
US

IV. Provider business mailing address

101 N PLAZA EAST BLVD STE 106
EVANSVILLE IN
47715-2804
US

V. Phone/Fax

Practice location:
  • Phone: 812-549-0049
  • Fax: 812-508-8478
Mailing address:
  • Phone: 812-549-0049
  • Fax: 812-508-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34007890A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: