=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487775334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DELAINE R STEHLE MA, PCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 10/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4648 PRESERVE DR NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44708-1590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-479-1522
-----------------------------------------------------
Fax | 330-479-1522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4648 PRESERVE DR NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44708-1590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-479-1522
-----------------------------------------------------
Fax | 330-479-1522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E-0007974
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------