Provider Demographics
NPI:1407914120
Name:DIAL, STELLA E (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:E
Last Name:DIAL
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1907
Mailing Address - Country:US
Mailing Address - Phone:231-726-2299
Mailing Address - Fax:231-728-6345
Practice Address - Street 1:1148 4TH ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-726-2299
Practice Address - Fax:231-728-6345
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F145260OtherMAGELLAN
BCBSOF14526OtherBCBS
S59316Medicare UPIN
BCBSOF14526OtherBCBS