Healthcare Provider Details

I. General information

NPI: 1922354331
Provider Name (Legal Business Name): TAMMY KAY STUTLER MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PROFESSIONAL PL STE 101
BRIDGEPORT WV
26330-4599
US

IV. Provider business mailing address

801 47TH AVE N
MYRTLE BEACH SC
29577-5402
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3495
  • Fax:
Mailing address:
  • Phone: 843-997-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3059
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6487
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: