Provider Demographics
NPI:1487052239
Name:STEPHENSON, JENNIFER L (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CASILLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:8565 S EASTERN AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2810
Mailing Address - Country:US
Mailing Address - Phone:702-701-3308
Mailing Address - Fax:702-701-3308
Practice Address - Street 1:8565 S EASTERN AVE STE 118
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2810
Practice Address - Country:US
Practice Address - Phone:702-701-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2823101YM0800X, 106H00000X
OKMFT803106H00000X
LAMFT27106H00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner