Provider Demographics
NPI:1568482057
Name:KITCHEN, STEPHANIE (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 TAYLOR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2282
Mailing Address - Country:US
Mailing Address - Phone:616-414-2167
Mailing Address - Fax:866-336-5072
Practice Address - Street 1:950 TAYLOR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2282
Practice Address - Country:US
Practice Address - Phone:616-414-2167
Practice Address - Fax:866-336-5072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK16101YP2500X
MI6401013609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional