Provider Demographics
NPI:1184212177
Name:STULL, ANASTASIA RENEE (MFTC)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:RENEE
Last Name:STULL
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BOULDER CRESCENT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3350
Mailing Address - Country:US
Mailing Address - Phone:720-292-6292
Mailing Address - Fax:
Practice Address - Street 1:10 BOULDER CRESCENT ST STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3350
Practice Address - Country:US
Practice Address - Phone:719-633-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014117106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist