Provider Demographics
NPI:1285415018
Name:STEPHENS, PHILLIP (LMSW)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3915
Mailing Address - Country:US
Mailing Address - Phone:479-785-4083
Mailing Address - Fax:479-434-6248
Practice Address - Street 1:1055 SUNFLOWER DR STE 104
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3651
Practice Address - Country:US
Practice Address - Phone:501-697-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13040-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical