Provider Demographics
NPI:1457999443
Name:HERNDON, STEPHANIE (PLPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HERNDON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S. INDEPENDENCE STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701
Mailing Address - Country:US
Mailing Address - Phone:816-380-4010
Mailing Address - Fax:816-887-5703
Practice Address - Street 1:316 S. INDEPENDENCE STREET
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701
Practice Address - Country:US
Practice Address - Phone:816-380-4010
Practice Address - Fax:816-887-5703
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019046847101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019046847OtherMISSOURI LICENSE