MEDICARE: HELEN ELIZABETH STACKHOUSE MASTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1043981608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN ELIZABETH STACKHOUSE MASTERS

Provider Business Mailing Address
First Line	:	2008 DAYBREAK CIR
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-9296
Country	:	US
Telephone Number	:	717-317-4596
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 DAYBREAK CIR
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-9296
Country	:	US
Telephone Number	:	717-317-4596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/23/2021

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