MEDICARE: HEATHER STAMBAUGH

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	101YM0800X	Mental Health Counselor	MH11554	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912221953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER STAMBAUGH

Provider Business Mailing Address
First Line	:	1253 W MEMORIAL BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-0602
Country	:	US
Telephone Number	:	863-271-7972
Fax Number	:	863-272-6599

Provider Business Practice Location Address
First Line	:	1253 W MEMORIAL BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-0602
Country	:	US
Telephone Number	:	863-271-7972
Fax Number	:	863-272-6599

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

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	05/23/2024

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Directions to “ HEATHER STAMBAUGH ” Practice Location

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