Healthcare Provider Details

I. General information

NPI: 1376973859
Provider Name (Legal Business Name): MARK DOUGLAS STEGEMAN MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13021 EVERGREEN DR
BAXTER MN
56425-7439
US

IV. Provider business mailing address

17396 SNOWSHOE DR
IRONTON MN
56455-2195
US

V. Phone/Fax

Practice location:
  • Phone: 218-829-9307
  • Fax:
Mailing address:
  • Phone: 651-497-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2524
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: