1336286640 NPI number — MS. MARY S. STEPHENSON MA, LPC

Table of content: MS. MARY S. STEPHENSON MA, LPC (NPI 1336286640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336286640 NPI number — MS. MARY S. STEPHENSON MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENSON
Provider First Name:
MARY
Provider Middle Name:
S.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336286640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8301 STATE LINE RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64114-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-444-2325
Provider Business Mailing Address Fax Number:
816-444-2326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8301 STATE LINE RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-444-2325
Provider Business Practice Location Address Fax Number:
816-444-2326
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  002753 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002753 . This is a "LPC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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