Healthcare Provider Details

I. General information

NPI: 1912162413
Provider Name (Legal Business Name): JEREMY JAMES STAPEL M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 STONE CREEK DR STE 140
CHANHASSEN MN
55317
US

IV. Provider business mailing address

7945 STONE CREEK DR STE 140
CHANHASSEN MN
55317-4606
US

V. Phone/Fax

Practice location:
  • Phone: 952-974-3999
  • Fax: 952-974-3780
Mailing address:
  • Phone: 952-974-3999
  • Fax: 952-974-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: