Provider Demographics
NPI:1518197169
Name:WILSON, STEFFANY DAWN (LPC)
Entity Type:Individual
Prefix:MISS
First Name:STEFFANY
Middle Name:DAWN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 IDAHO RD
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-1076
Mailing Address - Country:US
Mailing Address - Phone:316-305-2695
Mailing Address - Fax:
Practice Address - Street 1:1709 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2505
Practice Address - Country:US
Practice Address - Phone:620-432-5200
Practice Address - Fax:620-432-5222
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC 897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional