Provider Demographics
NPI:1093051229
Name:CLEMMONS, STEPHANIE JO (MED, LPCC, LPAT, ATR)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JO
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:MED, LPCC, LPAT, ATR
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JO
Other - Last Name:CLEMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPCC, LPAT, ATR
Mailing Address - Street 1:3917 HYCLIFFE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3838
Mailing Address - Country:US
Mailing Address - Phone:502-291-4094
Mailing Address - Fax:502-237-9072
Practice Address - Street 1:3917 HYCLIFFE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3838
Practice Address - Country:US
Practice Address - Phone:502-291-4094
Practice Address - Fax:502-237-9072
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-16
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1322101YP2500X
KY103057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional