Healthcare Provider Details

I. General information

NPI: 1922919315
Provider Name (Legal Business Name): STEFANI PROKOTT MSE, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MAPLE ST
BRAINERD MN
56401-3770
US

IV. Provider business mailing address

823 MAPLE ST
BRAINERD MN
56401-3770
US

V. Phone/Fax

Practice location:
  • Phone: 218-454-3826
  • Fax: 218-454-1024
Mailing address:
  • Phone: 218-454-3826
  • Fax: 218-454-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5859
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: