Provider Demographics
NPI:1609907393
Name:SUNDBY, STEPHEN MARK (PHD, LPC, CDC I)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARK
Last Name:SUNDBY
Suffix:
Gender:M
Credentials:PHD, LPC, CDC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874756
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4756
Mailing Address - Country:US
Mailing Address - Phone:907-357-5188
Mailing Address - Fax:
Practice Address - Street 1:602 CHASE AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574
Practice Address - Country:US
Practice Address - Phone:907-424-8300
Practice Address - Fax:907-424-8645
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK245101Y00000X
TX16231101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor