Provider Demographics
NPI:1023385697
Name:STERNBURGH, LUCILLE ELISE (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:ELISE
Last Name:STERNBURGH
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7019 OAK HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009
Mailing Address - Country:US
Mailing Address - Phone:248-931-3676
Mailing Address - Fax:
Practice Address - Street 1:7019 OAK HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-6580
Practice Address - Country:US
Practice Address - Phone:248-931-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2024-01-31
Deactivation Date:2021-06-08
Deactivation Code:
Reactivation Date:2022-03-09
Provider Licenses
StateLicense IDTaxonomies
MI224Y00000X
MI6401223531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist