Provider Demographics
NPI:1033265756
Name:REPPUHN, STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:REPPUHN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:03198 REYCRAFT
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712
Mailing Address - Country:US
Mailing Address - Phone:231-347-0456
Mailing Address - Fax:231-348-0800
Practice Address - Street 1:2810 CHARLEVOIX AVE STE 102
Practice Address - Street 2:ARROWHEAD COMMONS
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8421
Practice Address - Country:US
Practice Address - Phone:231-347-6542
Practice Address - Fax:231-348-0800
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI037196OtherMAGELLAN
MI11286845OtherCAQH ID
MI680B44503OtherBCBS ID
MI11286845OtherCAQH ID