Provider Demographics
NPI:1063800845
Name:STEPHENS, AMI REBECCA (LPCC)
Entity type:Individual
Prefix:MRS
First Name:AMI
Middle Name:REBECCA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 CHERRYWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031
Mailing Address - Country:US
Mailing Address - Phone:502-755-9987
Mailing Address - Fax:
Practice Address - Street 1:13000 EQUITY PLACE SUITE 106
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-755-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health