| Doctor Name: | MS. HEIDI STANFIELD |
| NPI Number: | 1154731214 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.L.P.C. |
| License Number: | 2014012605 |
| Business Practice Address: | 130 Calo Ln Lake Ozark, MO - 650499208 |
| Business Phone Number: | 5737467375 |
| Business Fax Number: | 5733652224 |
| Mailing Address: | Po Box 567, CAMDENTON |
| State: | MO |
| Postal Code: | 650200567 |
| Phone Number: | 5732163158 |
| Fax Number: | |
| NPI Enumeration Date: | 04/29/2014 |
| NPI Last Update Date: | 04/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2014012605 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |