Provider Demographics
NPI:1427223387
Name:STIDWELL, CAROLYN SUE (LMHC, LMSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:SUE
Last Name:STIDWELL
Suffix:
Gender:F
Credentials:LMHC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E 6TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6300
Mailing Address - Country:US
Mailing Address - Phone:515-232-0390
Mailing Address - Fax:
Practice Address - Street 1:103 E 6TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6300
Practice Address - Country:US
Practice Address - Phone:515-232-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health