Provider Demographics
NPI:1114053485
Name:STUMBO, JAMIE MICHELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
Last Name:STUMBO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 TERRY LN
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1668
Mailing Address - Country:US
Mailing Address - Phone:859-331-1796
Mailing Address - Fax:859-331-1819
Practice Address - Street 1:543 TERRY LN
Practice Address - Street 2:SUITE # 2
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1668
Practice Address - Country:US
Practice Address - Phone:859-331-1796
Practice Address - Fax:859-331-1819
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0623106H00000X
KY105551106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100297820Medicaid