MEDICARE: HELENE F. STOLLER

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	103TC0700X	Clinical Psychologist	1017	SC

General Provider Information

NPI Number	:	1629074604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELENE F. STOLLER

Provider Business Mailing Address
First Line	:	2 LITTLE JOHNS RETREAT
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-5705
Country	:	US
Telephone Number	:	843-290-6828
Fax Number	:	843-757-6289

Provider Business Practice Location Address
First Line	:	23 PLANTATION PARK RD
Second Line	:	BLDG 400
City	:	BLUFFTON
State	:	SC
Zip	:	29910-9009
Country	:	US
Telephone Number	:	843-290-6828
Fax Number	:	843-757-3993

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	01/16/2008

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