Provider Demographics
NPI:1184895104
Name:SUTHERLAND, STANFORD SCOTT (LPC)
Entity type:Individual
Prefix:
First Name:STANFORD
Middle Name:SCOTT
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:225 S ACADEMY BLVD
Mailing Address - Street 2:SUITE 104C
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2768
Mailing Address - Country:US
Mailing Address - Phone:719-471-0800
Mailing Address - Fax:719-471-0808
Practice Address - Street 1:225 S ACADEMY BLVD
Practice Address - Street 2:SUITE 104C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2768
Practice Address - Country:US
Practice Address - Phone:719-471-0800
Practice Address - Fax:719-471-0808
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional