Provider Demographics
NPI:1255655619
Name:DARK, STEPHANIE MARIE (MS, PLPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:DARK
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PLPC
Mailing Address - Street 1:3100 NE 83RD ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-4400
Mailing Address - Country:US
Mailing Address - Phone:815-508-1600
Mailing Address - Fax:816-468-0289
Practice Address - Street 1:3100 NE 83RD ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-4400
Practice Address - Country:US
Practice Address - Phone:815-508-1600
Practice Address - Fax:816-468-0289
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009037875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health