Provider Demographics
NPI:1013396225
Name:STINSON MEDIATION, LLC
Entity Type:Organization
Organization Name:STINSON MEDIATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:MARLOWE
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-663-8550
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756-0097
Mailing Address - Country:US
Mailing Address - Phone:423-663-8550
Mailing Address - Fax:
Practice Address - Street 1:308 COURT STREET
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756
Practice Address - Country:US
Practice Address - Phone:423-663-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012094Medicaid
TNQ012094OtherMEDICARE