Provider Demographics
NPI:1013434794
Name:ANDERSON, STEPHANIE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HICKORY POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5009
Mailing Address - Country:US
Mailing Address - Phone:937-554-6730
Mailing Address - Fax:
Practice Address - Street 1:206 HICKORY POINTE DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-5009
Practice Address - Country:US
Practice Address - Phone:937-554-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII131054101YA0400X
TN1526101YA0400X
OHC2103159101YP2500X
TN5899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)