Provider Demographics
NPI:1487940839
Name:STALLCUP, BOBIE LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:BOBIE
Middle Name:LYNN
Last Name:STALLCUP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24900 HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-5558
Mailing Address - Country:US
Mailing Address - Phone:661-822-4402
Mailing Address - Fax:661-823-3362
Practice Address - Street 1:24900 HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-5558
Practice Address - Country:US
Practice Address - Phone:661-822-4402
Practice Address - Fax:661-823-3362
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22235103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical