Provider Demographics
NPI:1851951032
Name:COONROD, STEPHEN (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:COONROD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 YORKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2231
Mailing Address - Country:US
Mailing Address - Phone:859-536-1357
Mailing Address - Fax:
Practice Address - Street 1:30 STACY LANE RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7356
Practice Address - Country:US
Practice Address - Phone:606-723-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2541441041C0700X
KY2564711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical