Provider Demographics
NPI:1063803492
Name:STALLWORTH, JANELL (LMHC)
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49214
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-6214
Mailing Address - Country:US
Mailing Address - Phone:941-623-6355
Mailing Address - Fax:
Practice Address - Street 1:8051 N TAMIAMI TRL STE E2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2032
Practice Address - Country:US
Practice Address - Phone:941-623-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health