Provider Demographics
NPI:1942711007
Name:VANAUSDALE, STEVIE LYNN BEALE (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:STEVIE
Middle Name:LYNN BEALE
Last Name:VANAUSDALE
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:STEVIE
Other - Middle Name:LYNN
Other - Last Name:BEALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 NW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4967
Mailing Address - Country:US
Mailing Address - Phone:352-513-8551
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 8TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4967
Practice Address - Country:US
Practice Address - Phone:352-513-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18075101YM0800X
FL15806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health