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General NPI Number Information
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NPI Number | 1770583007
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Entity Type | Individual
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Provider Name | JUDITH O STANSBERRY LPC/MHSP
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 109 STEKOIA LN
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City | KNOXVILLE
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State | TN
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Zip | 37912-1608
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Country | US
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Telephone | 865-938-4381
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Fax | 865-938-4382
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Provider Business Mailing Address
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Address Line | PO BOX 50834
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City | KNOXVILLE
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State | TN
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Zip | 37950-0834
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Country | US
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Telephone | 865-938-4381
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Fax | 865-938-4382
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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 | LPC0000000680
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License Number State | TN
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