Provider Demographics
NPI:1689655201
Name:STUTHERS, STUART (MS, LHMC)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:STUTHERS
Suffix:
Gender:M
Credentials:MS, LHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510297
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0297
Mailing Address - Country:US
Mailing Address - Phone:941-268-4500
Mailing Address - Fax:941-639-9498
Practice Address - Street 1:900 W MARION AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5308
Practice Address - Country:US
Practice Address - Phone:941-268-4500
Practice Address - Fax:941-639-9498
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z6175OtherBLUE CROSS BLUE SHIELD