Provider Demographics
NPI:1194923185
Name:MARSHALL, STEPHANIE M
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:6401 CYPRESS POINT DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3211
Mailing Address - Country:US
Mailing Address - Phone:318-345-3954
Mailing Address - Fax:318-345-3954
Practice Address - Street 1:3200 CONCORDIA AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5113
Practice Address - Country:US
Practice Address - Phone:318-362-5188
Practice Address - Fax:318-362-5215
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2780101YP2500X
LA795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist