Provider Demographics
NPI:1013559855
Name:MAYBERRY, STEPHANIE L (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4811 S 76TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4352
Mailing Address - Country:US
Mailing Address - Phone:414-361-1400
Mailing Address - Fax:
Practice Address - Street 1:4811 S 76TH ST STE 208
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4352
Practice Address - Country:US
Practice Address - Phone:414-361-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7442-125101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7442-125OtherPROFESSIONAL LICENSE