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General NPI Number Information
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NPI Number | 1871903658
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Entity Type | Individual
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Provider Name | BRANDON LEE STOOTHOFF MS, LPC
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Gender | Male
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 523 W CHOCOLATE AVE FL 2
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City | HERSHEY
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State | PA
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Zip | 17033-1629
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Country | US
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Telephone | 845-594-3172
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Fax |
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Provider Business Mailing Address
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Address Line | 10 W ELM ST
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City | PALMYRA
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State | PA
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Zip | 17078-3104
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Country | US
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Telephone | 845-594-3172
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC008141
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License Number State | PA
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