Provider Demographics
NPI:1235842618
Name:STEPHENS, JENNIFER M (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-5327
Mailing Address - Country:US
Mailing Address - Phone:989-324-0778
Mailing Address - Fax:
Practice Address - Street 1:33 WHITE TAIL CREEK RD STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5896
Practice Address - Country:US
Practice Address - Phone:989-220-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health