Provider Demographics
NPI:1538539697
Name:STAPP, LONNIE M (LCPC)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:M
Last Name:STAPP
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W IRONWOOD DR STE 303
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2682
Mailing Address - Country:US
Mailing Address - Phone:208-771-5911
Mailing Address - Fax:208-518-1258
Practice Address - Street 1:1250 W IRONWOOD DR STE 303
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2682
Practice Address - Country:US
Practice Address - Phone:208-771-5911
Practice Address - Fax:208-518-1258
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health