Provider Demographics
NPI:1598583502
Name:STEPHAN, REBECCA (LCMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:LCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5281 JACKSON CT
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-2514
Mailing Address - Country:US
Mailing Address - Phone:231-408-8463
Mailing Address - Fax:
Practice Address - Street 1:5281 JACKSON CT
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-2514
Practice Address - Country:US
Practice Address - Phone:231-408-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011182281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical