1578596078 NPI number — MR. JEAN L STIMMELL LCMHC

Table of content: MR. JEAN L STIMMELL LCMHC (NPI 1578596078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578596078 NPI number — MR. JEAN L STIMMELL LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STIMMELL
Provider First Name:
JEAN
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578596078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 JENNESS POND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHWOOD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03261-3111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-942-5889
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 JENNESS POND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHWOOD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03261-3111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-942-5889
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  255 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: .114339 . This is a "TEAMSTERS BEHAVIORAL HEAL" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 118708 . This is a "BEHAVIORAL HEALTH NETWORK" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2163827 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 14Y001621NH01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30422461 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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