Provider Demographics
NPI:1649558057
Name:STEDJE, JUDY ROYCE (MA LPC LLC MEMBER)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ROYCE
Last Name:STEDJE
Suffix:
Gender:F
Credentials:MA LPC LLC MEMBER
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:ROYCE
Other - Last Name:GILLISPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-4709
Mailing Address - Country:US
Mailing Address - Phone:580-338-7082
Mailing Address - Fax:580-338-7082
Practice Address - Street 1:216 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4709
Practice Address - Country:US
Practice Address - Phone:580-338-7082
Practice Address - Fax:580-338-7082
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4495101YP2500X
TX58510101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional