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General NPI Number Information
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NPI Number | 1205250230
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Entity Type | Individual
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Provider Name | ALISHA STAPOR LPC, NCC, LLMFT
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Gender | Female
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 4071 S STRAITS HWY
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City | INDIAN RIVER
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State | MI
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Zip | 49749-8407
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Country | US
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Telephone | 231-238-2172
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Fax | 231-238-2173
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Provider Business Mailing Address
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Address Line | PO BOX 111
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City | INDIAN RIVER
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State | MI
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Zip | 49749-0111
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Country | US
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Telephone | 231-238-2172
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Fax | 231-238-2173
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401013049
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006600
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License Number State | MI
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