Provider Demographics
NPI:1962662601
Name:STEPHENS, KYMBERLY WYNNE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:WYNNE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:KYMBERLY
Other - Middle Name:WYNNE
Other - Last Name:SCHOEWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LAC
Mailing Address - Street 1:102 E SUNBRIDGE DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2830
Mailing Address - Country:US
Mailing Address - Phone:479-640-1464
Mailing Address - Fax:479-750-8967
Practice Address - Street 1:102 E SUNBRIDGE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2830
Practice Address - Country:US
Practice Address - Phone:479-640-1464
Practice Address - Fax:479-750-8967
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ARA0808054101YM0800X
ARP1308085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health