1508137399 NPI number — MS. STEPHANIE GABRIELLE MANGAN MRC, LPCC

Table of content: MS. STEPHANIE GABRIELLE MANGAN MRC, LPCC (NPI 1508137399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508137399 NPI number — MS. STEPHANIE GABRIELLE MANGAN MRC, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANGAN
Provider First Name:
STEPHANIE
Provider Middle Name:
GABRIELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MRC, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUMNER
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
GABRIELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MRC, LPCA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508137399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1092 DUVAL ST
Provider Second Line Business Mailing Address:
250
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40515-8908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-523-7383
Provider Business Mailing Address Fax Number:
859-523-7384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1092 DUVAL ST
Provider Second Line Business Practice Location Address:
250
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40515-8908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-523-7383
Provider Business Practice Location Address Fax Number:
859-523-7384
Provider Enumeration Date:
01/25/2012

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: 101YM0800X , with the licence number:  KY-1597 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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