Provider Demographics
NPI:1790437408
Name:STALDER, JAYME (LCSW)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:STALDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAYME
Other - Middle Name:R
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:533 SUMMIT VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5999
Mailing Address - Country:US
Mailing Address - Phone:931-561-4448
Mailing Address - Fax:
Practice Address - Street 1:1716 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4542
Practice Address - Country:US
Practice Address - Phone:931-320-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86381041C0700X
TN7952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical