Provider Demographics
NPI:1396323200
Name:STAHL, ISA
Entity type:Individual
Prefix:
First Name:ISA
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5382 SUPERSTITION DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-2537
Mailing Address - Country:US
Mailing Address - Phone:575-636-9344
Mailing Address - Fax:
Practice Address - Street 1:780 S WALNUT ST BLDG 5
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1425
Practice Address - Country:US
Practice Address - Phone:575-636-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCCMH0215761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health