Provider Demographics
NPI:1710347760
Name:STEPHENS, ANDREW (LMFT, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LMFT, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9074
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-9074
Mailing Address - Country:US
Mailing Address - Phone:318-840-6673
Mailing Address - Fax:
Practice Address - Street 1:4274 FRONT ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-4139
Practice Address - Country:US
Practice Address - Phone:318-840-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5632101YP2500X
LA1214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist