Provider Demographics
NPI:1518523422
Name:STEPHENS, JASIRA E (LMHC)
Entity Type:Individual
Prefix:
First Name:JASIRA
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2116
Mailing Address - Country:US
Mailing Address - Phone:716-884-0700
Mailing Address - Fax:
Practice Address - Street 1:227 THORN AVENUE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-882-4357
Practice Address - Fax:716-662-1636
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health