Provider Demographics
NPI:1336286640
Name:STEPHENSON, MARY S (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:S
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 STATE LINE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2025
Mailing Address - Country:US
Mailing Address - Phone:816-444-2325
Mailing Address - Fax:816-444-2326
Practice Address - Street 1:8301 STATE LINE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2025
Practice Address - Country:US
Practice Address - Phone:816-444-2325
Practice Address - Fax:816-444-2326
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002753OtherLPC