Provider Demographics
NPI:1104965243
Name:STADLER, JEFFREY GEORGE (MA LMHP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GEORGE
Last Name:STADLER
Suffix:
Gender:M
Credentials:MA LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-1501
Mailing Address - Country:US
Mailing Address - Phone:575-779-5719
Mailing Address - Fax:
Practice Address - Street 1:190 CENTRAL PARK SQ STE 204
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4005
Practice Address - Country:US
Practice Address - Phone:575-779-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE245674OtherMIDLANDS CHOICE
NE84609OtherBCBS