Provider Demographics
NPI:1649014796
Name:SOOTER, STEPHANIE JUNE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUNE
Last Name:SOOTER
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 1:307 DELMAR ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1605
Mailing Address - Country:US
Mailing Address - Phone:573-783-1779
Mailing Address - Fax:
Practice Address - Street 1:151 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1451
Practice Address - Country:US
Practice Address - Phone:573-222-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024015520101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor