Provider Demographics
NPI:1669299376
Name:STAMPER, ARIEL LANAE (BA, MA, EDS)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:LANAE
Last Name:STAMPER
Suffix:
Gender:F
Credentials:BA, MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 PINEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-4932
Mailing Address - Country:US
Mailing Address - Phone:740-285-6864
Mailing Address - Fax:
Practice Address - Street 1:514 UNION ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4368
Practice Address - Country:US
Practice Address - Phone:740-353-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201295137103TS0200X
OHOH3481171103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool