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General NPI Number Information
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NPI Number | 1437351277
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE MCGREGOR SUDP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 15407 E. MISSION AVE, SUITE 100 NEW HORIZON CARE CENTER INC
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037
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Country | US
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Telephone | 509-927-1543
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Fax |
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Provider Business Mailing Address
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Address Line | 3546 W VELA PL UNIT APOST
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City | POST FALLS
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State | ID
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Zip | 83854-8827
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Country | US
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Telephone | 509-770-5567
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | RC00044173
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License Number State | WA
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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 | CP00006193
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00006193
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License Number State | WA
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