Provider Demographics
NPI:1285772525
Name:STEPHAN, MICHELLE M (MS LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:BRATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-9741
Mailing Address - Country:US
Mailing Address - Phone:616-202-5052
Mailing Address - Fax:
Practice Address - Street 1:419 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-9741
Practice Address - Country:US
Practice Address - Phone:616-745-3494
Practice Address - Fax:616-327-4090
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013235101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor