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Individual
STEPHANIE LYNN WHITE EAGLE
Active
Individual
STEPHANIE LYNN WHITE EAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFT,CSAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11480-132
WI
106H00000X
Marriage & Family Therapist
Primary
1258-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184957334
—
WI
Enumeration date
09/04/2009
Last updated
10/24/2019
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