Provider Demographics
NPI:1306071246
Name:STINSON, PHYLLIS (COUNSLER)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:STINSON
Suffix:
Gender:F
Credentials:COUNSLER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 FREDERICA ST
Mailing Address - Street 2:STE#407
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3050
Mailing Address - Country:US
Mailing Address - Phone:270-683-7555
Mailing Address - Fax:812-359-4481
Practice Address - Street 1:920 FREDERICA ST
Practice Address - Street 2:STE#407
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3050
Practice Address - Country:US
Practice Address - Phone:270-683-7555
Practice Address - Fax:812-359-4481
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY- 0658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health