Provider Demographics
NPI:1376095927
Name:DEMIEN, STEPHEN PHILLIP (LMFT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PHILLIP
Last Name:DEMIEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 NEW YORK AVE APT B
Mailing Address - Street 2:
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-2217
Mailing Address - Country:US
Mailing Address - Phone:254-247-8497
Mailing Address - Fax:
Practice Address - Street 1:2440 NEW YORK AVE APT B
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2217
Practice Address - Country:US
Practice Address - Phone:254-247-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist