Healthcare Provider Details

I. General information

NPI: 1013842525
Provider Name (Legal Business Name): DEZBAH STUMPFF LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 EAGLE CT
SANTO DOMINGO PUEBLO NM
87052-1230
US

IV. Provider business mailing address

251 LA CUEVA RD
GLORIETA NM
87535-7004
US

V. Phone/Fax

Practice location:
  • Phone: 505-465-2733
  • Fax:
Mailing address:
  • Phone: 505-465-2733
  • Fax: 505-465-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0400
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: