Healthcare Provider Details

I. General information

NPI: 1497316491
Provider Name (Legal Business Name): CATHERINE LYNN STEPHAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 W 10 MILE RD STE 106
SOUTHFIELD MI
48075-2100
US

IV. Provider business mailing address

15700 W 10 MILE RD STE 106
SOUTHFIELD MI
48075-2100
US

V. Phone/Fax

Practice location:
  • Phone: 989-225-4111
  • Fax: 248-575-4555
Mailing address:
  • Phone: 989-225-4111
  • Fax: 248-575-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801088542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: