Individual
MARISA ANN STACKPOOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21 HAWTHORNE ST, MEDFORD, OR 97504-7113
(458) 226-2339
Mailing address
21 HAWTHORNE ST, MEDFORD, OR 97504-7113
(458) 226-2339
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OR
101YP2500X
Professional Counselor
Primary
C11174
OR
Other
Enumeration date
07/07/2021
Last updated
02/13/2026
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