Provider Demographics
NPI:1558532788
Name:STUFFLEBEEM, MERRETT A (LMFT)
Entity Type:Individual
Prefix:
First Name:MERRETT
Middle Name:A
Last Name:STUFFLEBEEM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MERRETT
Other - Middle Name:
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 92364
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89009-2364
Mailing Address - Country:US
Mailing Address - Phone:408-410-8786
Mailing Address - Fax:
Practice Address - Street 1:3102 O ST STE 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6544
Practice Address - Country:US
Practice Address - Phone:408-410-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-15
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49177101YM0800X, 106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty