Healthcare Provider Details

I. General information

NPI: 1912348475
Provider Name (Legal Business Name): NATHANAEL MARK STEPHENS LP, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 WAVERLY RD
DIMONDALE MI
48821-9642
US

IV. Provider business mailing address

2580 EATON RAPIDS RD
LANSING MI
48911-6307
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-6410
  • Fax: 517-882-9969
Mailing address:
  • Phone: 517-342-4253
  • Fax: 517-882-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301018886
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: