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General NPI Number Information
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NPI Number | 1164572913
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Entity Type | Organization
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Legal Business Name | BRENDA STOOPS COUNSELING, LLC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 10305 DAWSONS CREEK BLVD SUITE C
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City | FORT WAYNE
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State | IN
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Zip | 46825-1914
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Country | US
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Telephone | 260-416-0600
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Fax | 260-416-0601
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Provider Business Mailing Address
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Address Line | 10305 DAWSONS CREEK BLVD SUITE C
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City | FORT WAYNE
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State | IN
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Zip | 46825-1914
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Country | US
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Telephone | 260-416-0600
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Fax | 260-416-0601
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BRENDA KAY LEE STOOPS
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Credential | LMHC
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Telephone | 260-416-0600
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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 | 39001280A
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License Number State | IN
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