Provider Demographics
NPI:1316407166
Name:CHURCHILL, STEPHANY M (MS LCMHC)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:M
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:MS LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:49 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:VT
Practice Address - Zip Code:05047-0709
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-295-0820
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134421101YM0800X
VT097.0134397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional