Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301011835 | MI |
NPI | 1023061132 |
---|---|
Provider Name | Stephen J Albrecht |
First Address | Byron Center, MI 49315-9482 |
Second Address | Byron Center, MI 49315-9482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 13/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P108975800 | BCBS PERSONAL PIN (01) | MI |