Provider Demographics
NPI:1407503931
Name:STEPHENS, SHIRLEY (LMHC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SUDDERTH DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6103
Mailing Address - Country:US
Mailing Address - Phone:575-630-0571
Mailing Address - Fax:
Practice Address - Street 1:1400 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6103
Practice Address - Country:US
Practice Address - Phone:505-247-7492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health