Provider Demographics
NPI:1518367739
Name:FILLMORE, STEPHANIE (LCSW, MFT, CACII)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FILLMORE
Suffix:
Gender:F
Credentials:LCSW, MFT, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10233 S PARKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9365
Mailing Address - Country:US
Mailing Address - Phone:720-446-6412
Mailing Address - Fax:720-222-5428
Practice Address - Street 1:10233 S PARKER RD STE 300
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9365
Practice Address - Country:US
Practice Address - Phone:720-446-6412
Practice Address - Fax:720-222-5428
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099254101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical