1437278249 NPI number — DELTA-WAVERLY PSYCHOLOGY AND COUNSELING ASSOCIATES, PLC

Table of content: STACY ANN STRUBLE ATC (NPI 1861452013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437278249 NPI number — DELTA-WAVERLY PSYCHOLOGY AND COUNSELING ASSOCIATES, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA-WAVERLY PSYCHOLOGY AND COUNSELING ASSOCIATES, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437278249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 S CREYTS RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48917-8234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-323-4099
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S CREYTS RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48917-8234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-323-4099
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITING
Authorized Official First Name:
GLENDA
Authorized Official Middle Name:
LOU
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
517-323-4099

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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