Provider Demographics
NPI:1790840783
Name:STAFFORD, EMILY J (MS, LPCC, LADAC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:J
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MS, LPCC, LADAC
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 580
Mailing Address - Street 2:
Mailing Address - City:ISLETA
Mailing Address - State:NM
Mailing Address - Zip Code:87022-0580
Mailing Address - Country:US
Mailing Address - Phone:505-869-5479
Mailing Address - Fax:505-869-4584
Practice Address - Street 1:01 SAGEBRUSH STREET
Practice Address - Street 2:
Practice Address - City:ISLETA
Practice Address - State:NM
Practice Address - Zip Code:87022
Practice Address - Country:US
Practice Address - Phone:505-869-5479
Practice Address - Fax:505-869-5484
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional