# STOMPTHERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235585837
- **Authorized official:** MR. GERALD DAVID NICKLEN LICSW (PRESIDENT STOMPTHERAPY, LLC)
- **Authorized official phone:** (850) 543-7776

## Contact information

- **Practice address:** 201 DUCK CREEK LN, GEORGETOWN, TX 78633-4114
- **Practice address phone:** (850) 543-7776
- **Mailing address:** 201 DUCK CREEK LN, GEORGETOWN, TX 78633-4114
- **Mailing address phone:** (850) 543-7776

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 60420 | TX | Yes |

## Other

- **Enumeration date:** 05/12/2016
- **Last updated:** 05/12/2016