Healthcare Provider Details

I. General information

NPI: 1043384886
Provider Name (Legal Business Name): SUSANNE BETH STOCKMAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 2ND ST SUITE 20
SANTA FE NM
87505-3499
US

IV. Provider business mailing address

369 MONTEZUMA AVE # 937
SANTA FE NM
87501-2626
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-1346
  • Fax: 505-820-6863
Mailing address:
  • Phone: 505-690-1346
  • Fax: 505-820-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0070951
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: