Provider Demographics
NPI:1760008643
Name:MABOLOC, STEFFI
Entity Type:Individual
Prefix:
First Name:STEFFI
Middle Name:
Last Name:MABOLOC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 ASPEN GROVE DR STE 350
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2912
Mailing Address - Country:US
Mailing Address - Phone:615-721-5921
Mailing Address - Fax:
Practice Address - Street 1:3351 ASPEN GROVE DR STE 350
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2912
Practice Address - Country:US
Practice Address - Phone:615-721-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician