Basic Information
| Provider Information | |||||||||
| NPI: | 1396462966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STALBAUM | ||||||||
| FirstName: | JULIE ANN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1707 LINWOOD DR STE G1707 | ||||||||
| Address2: | |||||||||
| City: | PARAGOULD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724505364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706044455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9101 N RODNEY PARHAM RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722051685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013898100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2022 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 11417-M | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.