Provider Demographics
NPI:1265734511
Name:STEPHEN, GLORIA (LPC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:STEPHEN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 WALL ST STE 231
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3546
Mailing Address - Country:US
Mailing Address - Phone:636-293-0044
Mailing Address - Fax:636-724-6349
Practice Address - Street 1:1550 WALL ST
Practice Address - Street 2:SUITE 231
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3545
Practice Address - Country:US
Practice Address - Phone:636-925-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional