Provider Demographics
NPI:1558244533
Name:EDDY, STEPHANIE (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:EDDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:CHISM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1158 BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-1525
Mailing Address - Country:US
Mailing Address - Phone:573-489-4462
Mailing Address - Fax:
Practice Address - Street 1:1158 BRANCH RD
Practice Address - Street 2:
Practice Address - City:HOLTS SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:65043-1525
Practice Address - Country:US
Practice Address - Phone:573-489-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160401531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical