Doctor Name: | MR. BENJAMIN MITCHELL STULLER |
NPI Number: | 1710274782 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.C. |
License Number: | PC004384 |
Business Practice Address: | 108 High St Edinboro, PA - 164122536 |
Business Phone Number: | 8147343975 |
Business Fax Number: | |
Mailing Address: | 108 High St, EDINBORO |
State: | PA |
Postal Code: | 164122536 |
Phone Number: | 8147343975 |
Fax Number: | |
NPI Enumeration Date: | 06/29/2011 |
NPI Last Update Date: | 06/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC004384 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |