| Doctor Name: | MR. TERRY LEE CORYELL STOTLER |
| NPI Number: | 1306904875 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, BCD |
| License Number: | DP00942520 |
| Business Practice Address: | 6719 Doolittle Dr Edwards, CA - 935232105 |
| Business Phone Number: | 6612722183 |
| Business Fax Number: | 6612754099 |
| Mailing Address: | 6719 Doolittle Dr, EDWARDS |
| State: | CA |
| Postal Code: | 935232105 |
| Phone Number: | 6612722183 |
| Fax Number: | 6612754099 |
| NPI Enumeration Date: | 12/05/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | DP00942520 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |