Provider Demographics
NPI:1619415452
Name:STEPHENS, MICHAEL (LPC, NCC, MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LPC, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 LEHMER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 MATHEWS ST
Practice Address - Street 2:ONE CORPORATE CIRCLE - SUITE 2000
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6939
Practice Address - Country:US
Practice Address - Phone:724-850-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health