Healthcare Provider Details

I. General information

NPI: 1699058867
Provider Name (Legal Business Name): STEPHANIE EHMKE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9285 WILLOW RD
WILLIS MI
48191-9736
US

IV. Provider business mailing address

9285 WILLOW RD
WILLIS MI
48191-9736
US

V. Phone/Fax

Practice location:
  • Phone: 636-234-1882
  • Fax:
Mailing address:
  • Phone: 636-234-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011025649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: