Provider Demographics
NPI:1306955570
Name:BENTLEY, STEPHEN (PHD, LPCC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 POPLAR LEVEL RD # B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1009
Mailing Address - Country:US
Mailing Address - Phone:502-456-9998
Mailing Address - Fax:502-456-9923
Practice Address - Street 1:3509 POPLAR LEVEL RD # B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1009
Practice Address - Country:US
Practice Address - Phone:502-456-9998
Practice Address - Fax:502-456-9923
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health