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General NPI Number Information
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NPI Number | 1669848024
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Entity Type | Individual
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Provider Name | STACY KONTUR LPC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 13101 ALLEN RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-2216
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Country | US
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Telephone | 734-785-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 7109 SCHULER AVE
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City | NEWPORT
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State | MI
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Zip | 48166-9737
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Country | US
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Telephone | 734-777-5655
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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 | 6401224446
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License Number State | MI
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