Provider Demographics
NPI:1588335103
Name:ROSALIK, STEFAN FAIN (LPC)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:FAIN
Last Name:ROSALIK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:ROSALIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-290-1100
Mailing Address - Fax:
Practice Address - Street 1:899 N WILMOT RD STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1712
Practice Address - Country:US
Practice Address - Phone:520-290-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional