Provider Demographics
NPI:1750847042
Name:STOFFEL, TINA MARIE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:STOFFEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE B214
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2104
Mailing Address - Country:US
Mailing Address - Phone:480-744-4156
Mailing Address - Fax:480-546-4372
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE B214
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2104
Practice Address - Country:US
Practice Address - Phone:480-744-4156
Practice Address - Fax:480-546-4372
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-14186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional