Provider Demographics
NPI:1356780738
Name:SCOTT-KOTLUS, STEPHANIE WINFIELD (LPC, LMHC, EDM, MA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:WINFIELD
Last Name:SCOTT-KOTLUS
Suffix:
Gender:F
Credentials:LPC, LMHC, EDM, MA
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:WINFIELD
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:27172 WOODWARD AVE
Mailing Address - Street 2:#200
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0963
Mailing Address - Country:US
Mailing Address - Phone:248-546-0407
Mailing Address - Fax:248-548-1925
Practice Address - Street 1:27172 WOODWARD AVE
Practice Address - Street 2:#200
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0963
Practice Address - Country:US
Practice Address - Phone:248-546-0407
Practice Address - Fax:248-548-1925
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012364101YM0800X
NY000656-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health