Provider Demographics
NPI:1952980922
Name:MILLEA, STEFAN J (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:J
Last Name:MILLEA
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2758
Mailing Address - Country:US
Mailing Address - Phone:612-314-0349
Mailing Address - Fax:612-314-0350
Practice Address - Street 1:6800 78TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2758
Practice Address - Country:US
Practice Address - Phone:612-314-0349
Practice Address - Fax:612-314-0350
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional