Individual
STEPHANIE R THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMHC
Contact information
Practice address
616 E COLFAX AVE, STE 2, SOUTH BEND, IN 46617-2827
(269) 985-8217
(844) 930-4791
Mailing address
616 E COLFAX AVE, STE 2, SOUTH BEND, IN 46617
(269) 985-8217
(844) 930-4791
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39005154A
IN
Other
Enumeration date
10/10/2024
Last updated
03/24/2025
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