Provider Demographics
NPI:1124200845
Name:STOEFFLER, SUSAN ALLEENE (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALLEENE
Last Name:STOEFFLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5698
Mailing Address - Country:US
Mailing Address - Phone:530-303-8011
Mailing Address - Fax:530-237-1552
Practice Address - Street 1:312 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5698
Practice Address - Country:US
Practice Address - Phone:530-303-8011
Practice Address - Fax:530-237-1552
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health