Provider Demographics
NPI:1467409938
Name:STOPPELBEIN, LAURA A (PHD10)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:STOPPELBEIN
Suffix:
Gender:F
Credentials:PHD10
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GLENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5700
Mailing Address - Country:US
Mailing Address - Phone:205-795-3225
Mailing Address - Fax:205-795-3390
Practice Address - Street 1:150 GLENWOOD LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5700
Practice Address - Country:US
Practice Address - Phone:205-795-3225
Practice Address - Fax:205-795-3390
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS45723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00286791Medicaid
MSQ51422Medicare UPIN
MS00286791Medicaid
MS680000280Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER