Stephen Mark Sundby, PH.D., LPC, CDC I
Individual provider Active NPI Counselor · Cordova, AK
NPI 1609907393 · NPPES record last updated Jul 1, 2010
Key facts
- NPI
- 1609907393
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 245 (AK)
- Practice address
- 602 Chase Ave
Cordova, AK 99574 - Phone
- (907) 424-8300
- Fax
- (907) 424-8645
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16231 | TX | MD | Counselor |
| 245 | AK | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 245 | AK | Yes |
| Counselor | 101Y00000X | 16231 | TX |
Addresses
Primary practice location
602 Chase Ave
Cordova, AK 99574
Mailing address
PO Box 874756
Wasilla, AK 99687-4756
Phone (907) 357-5188
Other providers in Cordova, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.