Provider Demographics
NPI:1508137399
Name:MANGAN, STEPHANIE GABRIELLE (MRC, LPCC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:GABRIELLE
Last Name:MANGAN
Suffix:
Gender:F
Credentials:MRC, LPCC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:GABRIELLE
Other - Last Name:SUMNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MRC, LPCA
Mailing Address - Street 1:1092 DUVAL ST
Mailing Address - Street 2:250
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-8908
Mailing Address - Country:US
Mailing Address - Phone:859-523-7383
Mailing Address - Fax:859-523-7384
Practice Address - Street 1:1092 DUVAL ST
Practice Address - Street 2:250
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-8908
Practice Address - Country:US
Practice Address - Phone:859-523-7383
Practice Address - Fax:859-523-7384
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1597101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health