Healthcare Provider Details

I. General information

NPI: 1205199726
Provider Name (Legal Business Name): JOSIE STEPHENS TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 S TELEGRAPH RD
MONROE MI
48161-4056
US

IV. Provider business mailing address

21770 GUDITH RD
WOODHAVEN MI
48183-1559
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-3850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301015024
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: