1356780738 NPI number — MRS. STEPHANIE WINFIELD SCOTT-KOTLUS LPC, LMHC, ED.M., MA

Table of content: MRS. STEPHANIE WINFIELD SCOTT-KOTLUS LPC, LMHC, ED.M., MA (NPI 1356780738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356780738 NPI number — MRS. STEPHANIE WINFIELD SCOTT-KOTLUS LPC, LMHC, ED.M., MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT-KOTLUS
Provider First Name:
STEPHANIE
Provider Middle Name:
WINFIELD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LMHC, ED.M., MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCOTT
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
WINFIELD
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356780738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27172 WOODWARD AVE
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
ROYAL OAK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48067-0963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-546-0407
Provider Business Mailing Address Fax Number:
248-548-1925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27172 WOODWARD AVE
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48067-0963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-546-0407
Provider Business Practice Location Address Fax Number:
248-548-1925
Provider Enumeration Date:
06/19/2013

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: 101YM0800X , with the licence number:  6401012364 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 000656-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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