Provider Demographics
NPI:1346994480
Name:JENNIFER L STEPHENSON, PH.D. PLLC
Entity Type:Organization
Organization Name:JENNIFER L STEPHENSON, PH.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-701-3308
Mailing Address - Street 1:8565 S EASTERN AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2810
Mailing Address - Country:US
Mailing Address - Phone:702-701-3308
Mailing Address - Fax:702-441-1262
Practice Address - Street 1:8565 S EASTERN AVE STE 118
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2810
Practice Address - Country:US
Practice Address - Phone:702-701-3308
Practice Address - Fax:702-441-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1487052239Medicaid