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General NPI Number Information
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NPI Number | 1427223387
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Entity Type | Individual
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Provider Name | CAROLYN SUE STIDWELL L.M.H.C., L.M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 1100 ADAMS ST UNIT 128
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City | AMES
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State | IA
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Zip | 50010-4126
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Country | US
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Telephone | 515-232-0390
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 ADAMS ST UNIT 128
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City | AMES
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State | IA
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Zip | 50010-4126
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Country | US
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Telephone | 515-450-0223
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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 | 00104
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License Number State | IA
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