Provider Demographics
NPI:1790158558
Name:STAMPER, EDMUND JASON (LPC-MH, QMHP, NCC)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:JASON
Last Name:STAMPER
Suffix:
Gender:M
Credentials:LPC-MH, QMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 W MAIN ST STE 311
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2447
Mailing Address - Country:US
Mailing Address - Phone:605-600-3733
Mailing Address - Fax:
Practice Address - Street 1:2040 W MAIN ST STE 311
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2447
Practice Address - Country:US
Practice Address - Phone:605-600-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC20325101Y00000X
SDLPC-MH30513101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional