Provider Demographics
NPI:1306105879
Name:LITTLE BRAVE, STEPHANIE M (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:LITTLE BRAVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-7033
Mailing Address - Country:US
Mailing Address - Phone:208-627-3775
Mailing Address - Fax:
Practice Address - Street 1:301 N 1ST AVE STE 202
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1457
Practice Address - Country:US
Practice Address - Phone:208-627-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-355961041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical