Provider Demographics
NPI:1588208730
Name:STINSON, EMMA GRACE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:GRACE
Last Name:STINSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 WILLA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2547
Mailing Address - Country:US
Mailing Address - Phone:847-302-2023
Mailing Address - Fax:
Practice Address - Street 1:5380 HOLIDAY TER STE 28
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2128
Practice Address - Country:US
Practice Address - Phone:847-302-2023
Practice Address - Fax:269-366-4004
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017897101YM0800X
MI6401222315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health