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General NPI Number Information
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NPI Number | 1225627110
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Entity Type | Individual
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Provider Name | MARYANN MICHELLE STOECKEL LADC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 701 DELLWOOD ST S # ED
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1920
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Country | US
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Telephone | 763-689-7700
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Fax | 612-262-9035
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Provider Business Mailing Address
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Address Line | 26514 DOLPHIN ST NW
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City | ZIMMERMAN
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State | MN
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Zip | 55398
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Country | US
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Telephone | 763-286-8191
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3187
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License Number State | MN
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