Provider Demographics
NPI:1447692058
Name:STEPHENS, STACY ANN (LMSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 POLK ST STE A
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3916
Mailing Address - Country:US
Mailing Address - Phone:208-737-0572
Mailing Address - Fax:
Practice Address - Street 1:550 POLK ST STE A
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3916
Practice Address - Country:US
Practice Address - Phone:208-737-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker