Provider Demographics
NPI:1083010136
Name:STEPHANIE LITTLEBRAVE
Entity Type:Organization
Organization Name:STEPHANIE LITTLEBRAVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE BRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-627-3775
Mailing Address - Street 1:252 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8296
Mailing Address - Country:US
Mailing Address - Phone:208-627-3775
Mailing Address - Fax:
Practice Address - Street 1:520 CEDAR ST
Practice Address - Street 2:SUITE E
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1569
Practice Address - Country:US
Practice Address - Phone:208-627-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty