Healthcare Provider Details

I. General information

NPI: 1366925828
Provider Name (Legal Business Name): AMY STOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 SELBY AVE
SAINT PAUL MN
55102-1726
US

IV. Provider business mailing address

493 SELBY AVE
SAINT PAUL MN
55102-1726
US

V. Phone/Fax

Practice location:
  • Phone: 651-212-4920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: