Provider Demographics
NPI:1447579883
Name:POWERS, STEPHANIE E (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:POWERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 PARK PLAZA AVE UNIT 106
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2286
Mailing Address - Country:US
Mailing Address - Phone:502-429-5431
Mailing Address - Fax:502-429-5439
Practice Address - Street 1:2843 BROWNSBORO RD STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1274
Practice Address - Country:US
Practice Address - Phone:502-234-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1589103T00000X
KY130711103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist