Provider Demographics
NPI:1669504189
Name:STIMPSON, MICKIE LYNN (LBSW)
Entity Type:Individual
Prefix:MS
First Name:MICKIE
Middle Name:LYNN
Last Name:STIMPSON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S COPPER ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5006
Mailing Address - Country:US
Mailing Address - Phone:505-546-8783
Mailing Address - Fax:505-546-4018
Practice Address - Street 1:501 W FLORIDA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-6302
Practice Address - Country:US
Practice Address - Phone:505-546-0427
Practice Address - Fax:505-546-6587
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB052761041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool