Provider Demographics
NPI:1114062643
Name:STEPHENSON, THERESA (LPCC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373
Mailing Address - Country:US
Mailing Address - Phone:937-440-7021
Mailing Address - Fax:937-440-7076
Practice Address - Street 1:3130 N COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373
Practice Address - Country:US
Practice Address - Phone:937-440-7021
Practice Address - Fax:937-440-7076
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:2007-04-04
Deactivation Code:
Reactivation Date:2007-05-09
Provider Licenses
StateLicense IDTaxonomies
OHE1663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional