Provider Demographics
NPI:1831831635
Name:STOCKWELL, EPHRAIM J III (LMFT, NCC)
Entity type:Individual
Prefix:MR
First Name:EPHRAIM
Middle Name:J
Last Name:STOCKWELL
Suffix:III
Gender:M
Credentials:LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-6229
Mailing Address - Country:US
Mailing Address - Phone:801-762-3091
Mailing Address - Fax:
Practice Address - Street 1:2111 HIGHVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1105
Practice Address - Country:US
Practice Address - Phone:801-762-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001339106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist