Provider Demographics
NPI:1396925384
Name:STUTZ-MIDDLETON, DEBRA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:STUTZ-MIDDLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:STUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9124 E MAIN ST STE 20-21
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-8700
Mailing Address - Country:US
Mailing Address - Phone:480-295-8070
Mailing Address - Fax:
Practice Address - Street 1:9124 E MAIN ST STE 20-21
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-8700
Practice Address - Country:US
Practice Address - Phone:480-295-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4244101YA0400X
CO9922011041C0700X
AZLCSW-124861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)