Provider Demographics
NPI:1821159773
Name:STEPHAN, LUKE F (MSW)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:F
Last Name:STEPHAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41677 FORD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3678
Mailing Address - Country:US
Mailing Address - Phone:734-981-3100
Mailing Address - Fax:734-981-6366
Practice Address - Street 1:41677 FORD RD
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3678
Practice Address - Country:US
Practice Address - Phone:734-981-3100
Practice Address - Fax:734-981-6366
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
MI68010614071041C0700X
MI4101005961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP11900Medicare ID - Type Unspecified