Provider Demographics
NPI:1710943287
Name:SHANK, STEPHANIE (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SHANK
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 OVERCUP ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5803
Mailing Address - Country:US
Mailing Address - Phone:317-440-4176
Mailing Address - Fax:775-288-3479
Practice Address - Street 1:13295 ILLINOIS ST
Practice Address - Street 2:SUITE 132
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3019
Practice Address - Country:US
Practice Address - Phone:317-440-4176
Practice Address - Fax:775-288-3479
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001720A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39001720AOtherLMHC
IN200835540 AMedicaid
IN201016750AMedicaid
IN200460530Medicaid