Healthcare Provider Details

I. General information

NPI: 1003104829
Provider Name (Legal Business Name): STEPHANIE A SUTTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SANTA FE AVE SUITE 300
SALINA KS
67401-4189
US

IV. Provider business mailing address

501 S SANTA FE AVE SUITE 300
SALINA KS
67401-4189
US

V. Phone/Fax

Practice location:
  • Phone: 785-452-4930
  • Fax: 785-452-4932
Mailing address:
  • Phone: 785-452-4930
  • Fax: 785-452-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2048
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: