Provider Demographics
NPI:1659350676
Name:STEPHANIE NEIDERMYER, LMFT, LLC
Entity Type:Organization
Organization Name:STEPHANIE NEIDERMYER, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIDERMYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:970-759-1923
Mailing Address - Street 1:128 W 14TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5100
Mailing Address - Country:US
Mailing Address - Phone:970-759-1923
Mailing Address - Fax:
Practice Address - Street 1:128 W 14TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5100
Practice Address - Country:US
Practice Address - Phone:970-759-1923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty