Provider Demographics
NPI:1134263734
Name:TERRI M STUTZKE PSYD PC
Entity type:Organization
Organization Name:TERRI M STUTZKE PSYD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIN. PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:623-535-0879
Mailing Address - Street 1:15610 W WHITTON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 EAST PLAZA CIRCLE
Practice Address - Street 2:SUITE 8
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340
Practice Address - Country:US
Practice Address - Phone:623-535-0879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2015-08-28
Deactivation Date:2007-07-18
Deactivation Code:
Reactivation Date:2008-06-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty