Provider Demographics
NPI:1104507839
Name:STEPHENS, BRIAN TODD (LAC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:TODD
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 PARADISE PLACE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9463
Mailing Address - Country:US
Mailing Address - Phone:479-790-3241
Mailing Address - Fax:
Practice Address - Street 1:3901 W FINANCIAL PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1471
Practice Address - Country:US
Practice Address - Phone:479-986-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2108001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health