Provider Demographics
NPI:1902058175
Name:STEPHENS, MEREDITH E (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:IRENE
Mailing Address - State:TX
Mailing Address - Zip Code:76650-0057
Mailing Address - Country:US
Mailing Address - Phone:254-678-9014
Mailing Address - Fax:254-678-3550
Practice Address - Street 1:3315 FM 308
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:TX
Practice Address - Zip Code:76660-3034
Practice Address - Country:US
Practice Address - Phone:254-678-9014
Practice Address - Fax:254-678-3550
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional