Provider Demographics
NPI:1235664798
Name:DEAN, STEPHANIE (N/A)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BUSINESS PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726
Mailing Address - Country:US
Mailing Address - Phone:888-417-5250
Mailing Address - Fax:225-341-8756
Practice Address - Street 1:106 BUSINESS PARK AVENUE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726
Practice Address - Country:US
Practice Address - Phone:888-417-5250
Practice Address - Fax:225-341-8756
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA6970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator