Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 6401015356 | MI |
NPI | 1003270133 |
---|---|
Provider Name | Stephanie Gogarn |
First Address | Lansing, MI 48910-5386 |
Second Address | Lansing, MI 48910-5386 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2016 |
Last Update Date | 05/04/2016 |