Provider Demographics
NPI:1871619247
Name:SZCZOTKA, STANLEY JOHN (PHD, MA LLP LPC,)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOHN
Last Name:SZCZOTKA
Suffix:
Gender:M
Credentials:PHD, MA LLP LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 FILMORE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-6721
Mailing Address - Country:US
Mailing Address - Phone:734-765-6900
Mailing Address - Fax:
Practice Address - Street 1:1255 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2215
Practice Address - Country:US
Practice Address - Phone:734-765-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009712101YP2500X
MI6301009801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical