Provider Demographics
NPI:1831857523
Name:BOMAR STAMM, HEATHER (LMHC, CATP, CCTP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BOMAR STAMM
Suffix:
Gender:F
Credentials:LMHC, CATP, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7338 COLBURY AVE
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6318
Mailing Address - Country:US
Mailing Address - Phone:407-476-6357
Mailing Address - Fax:
Practice Address - Street 1:5467 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-6332
Practice Address - Country:US
Practice Address - Phone:407-476-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health