MEDICARE: STEPHEN J ALBRECHT PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	6301011835	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P108975800	OTHER	MI	BCBS PERSONAL PIN

General Provider Information

NPI Number	:	1023061132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN J ALBRECHT PHD

Provider Business Mailing Address
First Line	:	2465 BYRON STATION DR SW
Second Line	:	SUITE C
City	:	BYRON CENTER
State	:	MI
Zip	:	49315-9482
Country	:	US
Telephone Number	:	616-583-8252
Fax Number	:	616-583-8254

Provider Business Practice Location Address
First Line	:	2465 BYRON STATION DR SW
Second Line	:	SUITE C
City	:	BYRON CENTER
State	:	MI
Zip	:	49315-9482
Country	:	US
Telephone Number	:	616-583-8252
Fax Number	:	616-583-8254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/13/2015

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