Provider Demographics
NPI:1689764714
Name:STEPHENSON, BOBBY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:LYNN
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 POPE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3520
Mailing Address - Country:US
Mailing Address - Phone:318-322-1286
Mailing Address - Fax:
Practice Address - Street 1:2005 POPE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3520
Practice Address - Country:US
Practice Address - Phone:318-322-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling