Provider Demographics
NPI:1982718516
Name:STEPHENS, GARY W (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:W
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2061
Mailing Address - Country:US
Mailing Address - Phone:214-813-7854
Mailing Address - Fax:972-283-1891
Practice Address - Street 1:402 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4600
Practice Address - Country:US
Practice Address - Phone:214-813-7854
Practice Address - Fax:972-283-1891
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0121531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical