Provider Demographics
NPI:1518361492
Name:STEPHENS, CALEB (LMSW, LAC)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LMSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 E CEDAR ST STE 115
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1791
Mailing Address - Country:US
Mailing Address - Phone:816-977-3178
Mailing Address - Fax:816-572-6838
Practice Address - Street 1:1715 E CEDAR ST STE 115
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1791
Practice Address - Country:US
Practice Address - Phone:816-977-3178
Practice Address - Fax:816-572-6838
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200101YA0400X
KS9328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12740301OtherCAQH