Provider Demographics
NPI:1962495317
Name:STALCUP, SUE SHEFFIELD (MS)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:SHEFFIELD
Last Name:STALCUP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 S CASA PRIETO DR
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85218-1891
Mailing Address - Country:US
Mailing Address - Phone:480-671-5630
Mailing Address - Fax:
Practice Address - Street 1:1423 S HIGLEY RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3429
Practice Address - Country:US
Practice Address - Phone:480-654-0992
Practice Address - Fax:480-325-5444
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC - 10388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional