Provider Demographics
NPI:1215003173
Name:HEAD, STEPHANIE KATHERINE (LMFT, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KATHERINE
Last Name:HEAD
Suffix:
Gender:F
Credentials:LMFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W JEFFERSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1111
Mailing Address - Country:US
Mailing Address - Phone:502-225-4540
Mailing Address - Fax:502-225-4541
Practice Address - Street 1:309 W JEFFERSON ST STE B
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1111
Practice Address - Country:US
Practice Address - Phone:502-225-4540
Practice Address - Fax:502-225-4541
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30621041C0700X
KY0613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist