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Organization
STOMPTHERAPY LLC
Active
Organization
STOMPTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD DAVID NICKLEN LICSW (PRESIDENT STOMPTHERAPY, LLC)
(850) 543-7776
Entity
Organization
Contact information
Practice address
201 DUCK CREEK LN, GEORGETOWN, TX 78633-4114
(850) 543-7776
Mailing address
201 DUCK CREEK LN, GEORGETOWN, TX 78633-4114
(850) 543-7776
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
60420
TX
Other
Enumeration date
05/12/2016
Last updated
05/12/2016
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