Provider Demographics
NPI:1760018147
Name:ROWELL, STEPHANIE KIM (LPC, CADC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KIM
Last Name:ROWELL
Suffix:
Gender:F
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 W WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-2155
Mailing Address - Country:US
Mailing Address - Phone:208-867-2240
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST STE 232
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1275
Practice Address - Country:US
Practice Address - Phone:208-867-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7504101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor