Healthcare Provider Details

I. General information

NPI: 1619008943
Provider Name (Legal Business Name): JEFFREY WILLIAM STAMBOOK MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

IV. Provider business mailing address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

V. Phone/Fax

Practice location:
  • Phone: 541-851-8110
  • Fax: 541-851-8114
Mailing address:
  • Phone: 541-841-8110
  • Fax: 541-851-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC43897
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT2065
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: