Provider Demographics
NPI:1407519051
Name:STEPHENSON, NORMAN JOHN (MSLADCLMHPCPCLIMHP)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:JOHN
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:MSLADCLMHPCPCLIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 KINGSGATE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4825
Mailing Address - Country:US
Mailing Address - Phone:308-672-5915
Mailing Address - Fax:308-635-6023
Practice Address - Street 1:2302 KINGSGATE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4825
Practice Address - Country:US
Practice Address - Phone:308-672-5915
Practice Address - Fax:308-635-6023
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health