Provider Demographics
NPI:1831309301
Name:STUMBO, JAMES SIDNEY (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SIDNEY
Last Name:STUMBO
Suffix:
Gender:M
Credentials:PHD, LMFT
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 503010
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-0813
Mailing Address - Country:US
Mailing Address - Phone:541-234-4781
Mailing Address - Fax:503-419-4662
Practice Address - Street 1:3550 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4148
Practice Address - Country:US
Practice Address - Phone:541-613-6667
Practice Address - Fax:503-419-4662
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500698785Medicaid