Doctor Name: | STEPHANIE WORMKE |
NPI Number: | 1487932968 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MHPP |
License Number: | |
Business Practice Address: | 949 N Main St Mulberry, AR - 729478538 |
Business Phone Number: | 4794525040 |
Business Fax Number: | 4794525047 |
Mailing Address: | Po Box 23070, BARLING |
State: | AR |
Postal Code: | 729230070 |
Phone Number: | 4794525040 |
Fax Number: | 4794525047 |
NPI Enumeration Date: | 08/01/2011 |
NPI Last Update Date: | 10/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |