Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0268 | KY |
N | 103T00000X | Psychologist | 0268 | KY |
Y | 102L00000X | Psychologist | 20010274A | IN |
Y | 103T00000X | Psychologist | 20010274A | IN |
N | 103G00000X | Clinical Psychologist | 0268 | KY |
N | 103TC0700X | Clinical Psychologist | 0268 | KY |
N | 103G00000X | Clinical Psychologist | 20010274A | IN |
N | 103TC0700X | Clinical Psychologist | 20010274A | IN |
N | 103TH0100X | Health Service | 0268 | KY |
N | 103TH0100X | Health Service | 20010274A | IN |
N | 103TM1800X | Intellectual & Developmental Disabilities | 0268 | KY |
N | 103TM1800X | Intellectual & Developmental Disabilities | 20010274A | IN |
N | 103TP2701X | Group Psychotherapist | 0268 | KY |
N | 103TP2701X | Group Psychotherapist | 20010274A | IN |
NPI | 1548322407 |
---|---|
Provider Name | Mrs. Dorothy W Stephens |
First Address | Evansville, IN 47714-0137 |
Second Address | Evansville, IN 47714-0137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 05/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000218521 | ANTHEM BC AND BS (01) | IN |
200491750A | (05) | IN |