Healthcare Provider Details

I. General information

NPI: 1447985155
Provider Name (Legal Business Name): MAXIMILIAN MARTIN STEPANIAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date: 02/03/2023
Reactivation Date: 02/28/2023

III. Provider practice location address

3011 EDEN AVE UNIT 3B
BELLEVUE KY
41073
US

IV. Provider business mailing address

301 EDEN AVE UNIT 3B
BELLEVUE KY
41073-1267
US

V. Phone/Fax

Practice location:
  • Phone: 513-910-7480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2606910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: