Basic Information
| Provider Information | |||||||||
| NPI: | 1013948884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEIMEL | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 W SUPERIOR ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899684017 | ||||||||
| FaxNumber: | 7076764621 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 W SUPERIOR ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899684017 | ||||||||
| FaxNumber: | 7076764621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 11/10/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801012357 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | 4101005986 | MI | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1031261 | 01 | MI | MCCLAREN HEALTH PLAN | OTHER | 8008937450 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER |