Provider Demographics
NPI:1588206346
Name:STORMZAND, CARRIE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:STORMZAND
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4546 S QUAIL CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1678
Mailing Address - Country:US
Mailing Address - Phone:417-209-5046
Mailing Address - Fax:
Practice Address - Street 1:4546 S QUAIL CREEK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1678
Practice Address - Country:US
Practice Address - Phone:417-209-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty