Provider Demographics
NPI:1508338815
Name:STUMBO, SEAN MICHAEL (MED, LPC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:STUMBO
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 11TH ST APT 114
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-0825
Mailing Address - Country:US
Mailing Address - Phone:614-657-2198
Mailing Address - Fax:
Practice Address - Street 1:601 11TH ST APT 114
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-0825
Practice Address - Country:US
Practice Address - Phone:614-657-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2023-08-22
Deactivation Date:2020-08-01
Deactivation Code:
Reactivation Date:2020-08-07
Provider Licenses
StateLicense IDTaxonomies
OHE.2203073101YP2500X
ALLPC04798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional