Provider Demographics
NPI:1639258957
Name:HORAK, STEPHANIE HELEN (MA, LLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HELEN
Last Name:HORAK
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:HELEN
Other - Last Name:SILVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:801 BROADWAY AVE NW
Mailing Address - Street 2:SUITE 443
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4462
Mailing Address - Country:US
Mailing Address - Phone:616-942-2327
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY AVE NW
Practice Address - Street 2:SUITE 443
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4462
Practice Address - Country:US
Practice Address - Phone:616-942-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012128103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist