Provider Demographics
NPI:1679675151
Name:STEPHENS, SANDRA S (LPC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:S
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3430
Mailing Address - Country:US
Mailing Address - Phone:903-874-1637
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-5215
Practice Address - Country:US
Practice Address - Phone:903-874-7133
Practice Address - Fax:903-874-1495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional