Provider Demographics
NPI:1881615672
Name:STAMMERJOHAN, SUSAN GASTELUM (LPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GASTELUM
Last Name:STAMMERJOHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 467 BOX 3216
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:HESSEN
Mailing Address - Zip Code:09096
Mailing Address - Country:DE
Mailing Address - Phone:337-1710
Mailing Address - Fax:
Practice Address - Street 1:CMR 467 BOX 3216
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:HESSEN
Practice Address - Zip Code:09096
Practice Address - Country:DE
Practice Address - Phone:337-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA843302101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)