Provider Demographics
NPI:1982066825
Name:STEPHENSON-LAFOREST, AMBER JO (TLLP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JO
Last Name:STEPHENSON-LAFOREST
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:JO
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1255 NORTH OAKLAND BLVD.
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327
Mailing Address - Country:US
Mailing Address - Phone:248-406-0090
Mailing Address - Fax:
Practice Address - Street 1:1255 N OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1545
Practice Address - Country:US
Practice Address - Phone:248-406-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical