Provider Demographics
NPI:1780634881
Name:LANKTON, STEPHEN RYAN (MSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RYAN
Last Name:LANKTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:RYAN
Other - Last Name:LANKTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 9489
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-9489
Mailing Address - Country:US
Mailing Address - Phone:602-532-0800
Mailing Address - Fax:602-532-0801
Practice Address - Street 1:3509 E SHEA BLVD
Practice Address - Street 2:STE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3336
Practice Address - Country:US
Practice Address - Phone:602-532-0800
Practice Address - Fax:602-532-0801
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-104431041C0700X
MI68010024381041C0700X
FLMT0121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ110043Medicare PIN