Provider Demographics
NPI:1306285457
Name:HEFNER, STEPHANIE (MA, RMHCI)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HEFNER
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5017
Mailing Address - Country:US
Mailing Address - Phone:941-957-8266
Mailing Address - Fax:
Practice Address - Street 1:6911 BELMONT CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5017
Practice Address - Country:US
Practice Address - Phone:941-957-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health