Provider Demographics
NPI:1659904951
Name:ANDERSON, STEPHANIE SPAIN (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SPAIN
Last Name:ANDERSON
Suffix:
Gender:
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 N COURTENAY PKWY STE 47
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4473
Mailing Address - Country:US
Mailing Address - Phone:321-305-4086
Mailing Address - Fax:321-978-9213
Practice Address - Street 1:1450 N COURTENAY PKWY STE 47
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4473
Practice Address - Country:US
Practice Address - Phone:321-305-4086
Practice Address - Fax:321-978-9213
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health