Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0155941 | NM |
N | 101YP2500X | Professional Counselor | LPC12877 | AZ |
NPI | 1003061946 |
---|---|
Provider Name | Mrs. Shelley Sue Stisser |
First Address | Goodyear, AZ 85338-5254 |
Second Address | Albuquerque, NM 87109-3155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2008 |
Last Update Date | 17/03/2018 |