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NPI Code Detail

MEDICARE: STEPHEN ALEXANDER KONZ LMHC

MEDICARE: STEPHEN ALEXANDER KONZ LMHC
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
1101YM0800XMental Health Counselor39001468AIN

General Provider Information

NPI Number : 1780680694
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN ALEXANDER KONZ LMHC
Provider Business Mailing Address
First Line : 850 N HARRISON ST
Second Line : C/O ANNE LAWSON
City : WARSAW
State : IN
Zip : 46580-3163
Country : US
Telephone Number : 574-267-7169
Fax Number : 574-269-5573
Provider Business Practice Location Address
First Line : 2100 GOSHEN RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46808-1493
Country : US
Telephone Number : 260-471-3500
Fax Number : 260-471-4263
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2005
Last Update Date : 08/30/2013

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