Healthcare Provider Details

I. General information

NPI: 1619257524
Provider Name (Legal Business Name): DARLENE A STIEBER PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 PEPPER ROAD
HOLLY MI
48442-8566
US

IV. Provider business mailing address

7975 PEPPER RD
HOLLY MI
48442-8566
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-7562
  • Fax: 586-207-1560
Mailing address:
  • Phone: 586-207-1560
  • Fax: 586-207-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301005948
License Number StateMI

VIII. Authorized Official

Name: APRIL GAGALA
Title or Position: OFFICE MANAGER/BILLER
Credential:
Phone: 586-322-5717