Provider Demographics
NPI:1003061946
Name:STISSER, SHELLEY SUE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:SUE
Last Name:STISSER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:SUE
Other - Last Name:STISSER-MCCRAIGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:9342 S 182ND LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-5254
Mailing Address - Country:US
Mailing Address - Phone:623-810-7266
Mailing Address - Fax:623-321-1378
Practice Address - Street 1:8205 SPAIN RD NE STE 106
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3155
Practice Address - Country:US
Practice Address - Phone:505-856-0300
Practice Address - Fax:505-856-7946
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC12877101YP2500X
NM0155941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional