Provider Demographics
NPI:1881339422
Name:STAMATES, SAVANNAH N
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:N
Last Name:STAMATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:NOELLE
Other - Last Name:STUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5244 LOMA LINDA LN NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1051
Mailing Address - Country:US
Mailing Address - Phone:330-323-3090
Mailing Address - Fax:
Practice Address - Street 1:5998 COHO ST UNIT D
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99506-3603
Practice Address - Country:US
Practice Address - Phone:330-323-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health