Provider Demographics
NPI:1659673366
Name:STONGER, MARK DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:STONGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 DOLORES ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3434
Mailing Address - Country:US
Mailing Address - Phone:719-640-3049
Mailing Address - Fax:
Practice Address - Street 1:5734 DOLORES ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3434
Practice Address - Country:US
Practice Address - Phone:719-640-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical