Provider Demographics
NPI:1659688430
Name:STAMBAUGH, SUZANNE LISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LISA
Last Name:STAMBAUGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 FOREST HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3505
Mailing Address - Country:US
Mailing Address - Phone:510-918-3344
Mailing Address - Fax:
Practice Address - Street 1:6448 E HWY 290 STE E110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1076
Practice Address - Country:US
Practice Address - Phone:512-467-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2013-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health