Provider Demographics
NPI:1962830620
Name:WILLIAMS, STEPHANIE (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BOOCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4796 CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-5845
Mailing Address - Country:US
Mailing Address - Phone:720-645-3373
Mailing Address - Fax:
Practice Address - Street 1:4796 CHAMPLAIN DR
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-5845
Practice Address - Country:US
Practice Address - Phone:720-645-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO742101YA0400X
CO12397101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)