Healthcare Provider Details

I. General information

NPI: 1225627110
Provider Name (Legal Business Name): MARYANN MICHELLE STOECKEL LADC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MARYANN MICHELLE WEINS

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date: 03/18/2021
Reactivation Date: 08/09/2022

III. Provider practice location address

701 DELLWOOD ST S # ED
CAMBRIDGE MN
55008-1920
US

IV. Provider business mailing address

26514 DOLPHIN ST NW
ZIMMERMAN MN
55398
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-7700
  • Fax: 612-262-9035
Mailing address:
  • Phone: 763-286-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3187
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: