Provider Demographics
NPI:1124685144
Name:LINDFORS, STEPHANIE R
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:LINDFORS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391136
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32739-1136
Mailing Address - Country:US
Mailing Address - Phone:407-405-3104
Mailing Address - Fax:
Practice Address - Street 1:17 FLORIDA PARK DR STE F
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3867
Practice Address - Country:US
Practice Address - Phone:386-264-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLIMH16059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst