Provider Demographics
NPI:1023061132
Name:ALBRECHT, STEPHEN J (PHD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:ALBRECHT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 BYRON STATION DR SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9482
Mailing Address - Country:US
Mailing Address - Phone:616-583-8252
Mailing Address - Fax:616-583-8254
Practice Address - Street 1:2465 BYRON STATION DR SW
Practice Address - Street 2:SUITE C
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9482
Practice Address - Country:US
Practice Address - Phone:616-583-8252
Practice Address - Fax:616-583-8254
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011835103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP108975800OtherBCBS PERSONAL PIN
MIP108975800OtherBCBS PERSONAL PIN