Provider Demographics
NPI:1487662490
Name:NETTLES, STEPHANIE COLLEEN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:COLLEEN
Last Name:NETTLES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3019
Mailing Address - Country:US
Mailing Address - Phone:734-255-5950
Mailing Address - Fax:
Practice Address - Street 1:1169 ELLINGTON RD
Practice Address - Street 2:ENHANCING BEHAVIORAL CHOICES
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3515
Practice Address - Country:US
Practice Address - Phone:860-289-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist