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General NPI Number Information
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NPI Number | 1104965243
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Entity Type | Individual
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Provider Name | JEFFREY GEORGE STADLER MA LMHP
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 190 CENTRAL PARK SQ STE 204
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City | LOS ALAMOS
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State | NM
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Zip | 87544-4005
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Country | US
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Telephone | 575-779-5719
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Fax |
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Provider Business Mailing Address
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Address Line | 2423 CLUB RD
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City | LOS ALAMOS
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State | NM
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Zip | 87544-1501
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Country | US
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Telephone | 575-779-5719
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2723
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License Number State | NE
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