Provider Demographics
NPI:1639415177
Name:COKER, STEPHANIE NELSON (LCSW, LCDC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NELSON
Last Name:COKER
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BASHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5168 VILLAGE CREEK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5096
Mailing Address - Country:US
Mailing Address - Phone:972-318-9272
Mailing Address - Fax:972-803-3099
Practice Address - Street 1:5168 VILLAGE CREEK DR
Practice Address - Street 2:STE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5096
Practice Address - Country:US
Practice Address - Phone:972-318-9272
Practice Address - Fax:972-803-3099
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX354541041C0700X
TX12619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)