Provider Demographics
NPI:1790808129
Name:STOLPE, MARCY (LPC)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:STOLPE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 ADELAIDE DR
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9396
Mailing Address - Country:US
Mailing Address - Phone:541-929-3085
Mailing Address - Fax:
Practice Address - Street 1:425 2ND AVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2482
Practice Address - Country:US
Practice Address - Phone:541-967-3866
Practice Address - Fax:541-812-8784
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health