Provider Demographics
NPI:1235561242
Name:STEPHENS, KATHRYN ANN (MA, LLPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 EATON RAPIDS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6307
Mailing Address - Country:US
Mailing Address - Phone:517-394-5332
Mailing Address - Fax:517-882-9969
Practice Address - Street 1:2580 EATON RAPIDS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6307
Practice Address - Country:US
Practice Address - Phone:517-394-5332
Practice Address - Fax:517-882-9969
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013677101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor