Provider Demographics
NPI:1578622833
Name:FROSLIE, STEPHANIE A (LMFT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:FROSLIE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 CLEARVIEW COURT
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6801
Mailing Address - Country:US
Mailing Address - Phone:701-212-3683
Mailing Address - Fax:218-233-3232
Practice Address - Street 1:810 4TH AVE S
Practice Address - Street 2:SUITE 272
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:701-212-3683
Practice Address - Fax:218-233-4343
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN597495000Medicaid