Provider Demographics
NPI:1619257524
Name:DARLENE A STIEBER PHD PC
Entity Type:Organization
Organization Name:DARLENE A STIEBER PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-322-5717
Mailing Address - Street 1:7975 PEPPER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-8566
Mailing Address - Country:US
Mailing Address - Phone:586-207-1560
Mailing Address - Fax:586-207-1862
Practice Address - Street 1:7975 PEPPER ROAD
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-8566
Practice Address - Country:US
Practice Address - Phone:586-228-7562
Practice Address - Fax:586-207-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI-2288Medicare PIN