Provider Demographics
NPI:1003622184
Name:STEPHENS, WESLEY CLAY (TCM)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:CLAY
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1371
Mailing Address - Country:US
Mailing Address - Phone:606-388-2898
Mailing Address - Fax:
Practice Address - Street 1:314 FERRY ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1371
Practice Address - Country:US
Practice Address - Phone:606-388-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator