Provider Demographics
NPI:1912456575
Name:NEWSOM, STEPHANIE (MA,LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:MA,LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3940
Mailing Address - Country:US
Mailing Address - Phone:319-230-6668
Mailing Address - Fax:
Practice Address - Street 1:118 1ST ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3321
Practice Address - Country:US
Practice Address - Phone:319-230-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional