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NPI Code Detail

MEDICARE: TONY STIDHAM

MEDICARE: TONY STIDHAM
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1255269676
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONY STIDHAM
Provider Business Mailing Address
First Line : 4001 OFFICE COURT DR STE 102
Second Line :
City : SANTA FE
State : NM
Zip : 87507-4903
Country : US
Telephone Number : 505-983-8225
Fax Number :
Provider Business Practice Location Address
First Line : 4001 OFFICE COURT DR STE 102
Second Line :
City : SANTA FE
State : NM
Zip : 87507-4903
Country : US
Telephone Number : 505-983-8225
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2026
Last Update Date : 05/13/2026

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Directions to “ TONY STIDHAM ” Practice Location

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