Provider Demographics
NPI:1124734637
Name:STEPHENS, CALLISTA JOANNE (MA, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:CALLISTA
Middle Name:JOANNE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1449
Mailing Address - Country:US
Mailing Address - Phone:612-361-8556
Mailing Address - Fax:612-338-3653
Practice Address - Street 1:1025 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1449
Practice Address - Country:US
Practice Address - Phone:612-361-8556
Practice Address - Fax:612-338-3653
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)