Provider Demographics
NPI:1245766104
Name:STOPHER, KIRSTEN LEIGH (LSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LEIGH
Last Name:STOPHER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1410
Mailing Address - Country:US
Mailing Address - Phone:419-906-9763
Mailing Address - Fax:
Practice Address - Street 1:41 WASHINGTON AVE STE 250
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1377
Practice Address - Country:US
Practice Address - Phone:213-880-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011192621041C0700X
OHS.1201422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health