Provider Demographics
NPI:1154961894
Name:STADLER, STEVEN JAMES (MA LADC LPCC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAMES
Last Name:STADLER
Suffix:
Gender:M
Credentials:MA LADC LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5341 BEACHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4115
Mailing Address - Country:US
Mailing Address - Phone:828-707-1645
Mailing Address - Fax:
Practice Address - Street 1:7831 E BUSH LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-3131
Practice Address - Country:US
Practice Address - Phone:763-760-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health