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General NPI Number Information
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NPI Number | 1003061946
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Entity Type | Individual
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Provider Name | SHELLEY SUE STISSER LPC
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Gender | Female
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 8205 SPAIN RD NE STE 106
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3155
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Country | US
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Telephone | 505-856-0300
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Fax | 505-856-7946
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Provider Business Mailing Address
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Address Line | 9342 S 182ND LN
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City | GOODYEAR
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State | AZ
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Zip | 85338-5254
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Country | US
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Telephone | 623-810-7266
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Fax | 623-321-1378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC12877
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0155941
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License Number State | NM
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