1205250230 NPI number — MRS. ALISHA STAPOR LPC, NCC, LLMFT

Table of content: MRS. ALISHA STAPOR LPC, NCC, LLMFT (NPI 1205250230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205250230 NPI number — MRS. ALISHA STAPOR LPC, NCC, LLMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAPOR
Provider First Name:
ALISHA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC, LLMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
ALISHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, NCC, LLMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205250230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIAN RIVER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49749-0111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-238-2172
Provider Business Mailing Address Fax Number:
231-238-2173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4071 S STRAITS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN RIVER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49749-8407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-238-2172
Provider Business Practice Location Address Fax Number:
231-238-2173
Provider Enumeration Date:
02/11/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  6401013049 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 4101006600 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)