Provider Demographics
NPI:1932855848
Name:MELISSA STAHL
Entity Type:Organization
Organization Name:MELISSA STAHL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:636-293-2361
Mailing Address - Street 1:1655 E HWY 50 STE 302J
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5056
Mailing Address - Country:US
Mailing Address - Phone:636-293-2361
Mailing Address - Fax:
Practice Address - Street 1:1655 E HWY 50 STE 302J
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5056
Practice Address - Country:US
Practice Address - Phone:636-293-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health