Provider Demographics
NPI:1013317619
Name:MCINELLY, STEPHANIE (BS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCINELLY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 E FRY BLVD
Mailing Address - Street 2:#3694
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2858
Mailing Address - Country:US
Mailing Address - Phone:509-724-0920
Mailing Address - Fax:
Practice Address - Street 1:2300 E FRY BLVD
Practice Address - Street 2:#3694
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2858
Practice Address - Country:US
Practice Address - Phone:509-724-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
AZLMFT-15440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health