Provider Demographics
NPI:1144598525
Name:DEAN, STEFANIE A (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:A
Last Name:DEAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MISS
Other - First Name:STEFANIE
Other - Middle Name:A
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4744 LIBERTY RD S STE 220
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5183
Mailing Address - Country:US
Mailing Address - Phone:541-200-5046
Mailing Address - Fax:503-385-8505
Practice Address - Street 1:4744 LIBERTY RD S STE 220
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:541-200-5046
Practice Address - Fax:503-385-8505
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X
ORC3144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500757950Medicaid