Provider Demographics
NPI:1598038234
Name:STEPPING STONES WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:STEPPING STONES WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:734-446-5466
Mailing Address - Street 1:595 FOREST AVE
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1775
Mailing Address - Country:US
Mailing Address - Phone:734-446-5466
Mailing Address - Fax:734-446-2716
Practice Address - Street 1:595 FOREST AVE
Practice Address - Street 2:SUITE 7A
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1775
Practice Address - Country:US
Practice Address - Phone:734-446-5466
Practice Address - Fax:734-446-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5706Medicare PIN