Provider Demographics
NPI:1316902588
Name:HARRISON, STEPHANIE (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 ENERGY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-2941
Mailing Address - Country:US
Mailing Address - Phone:307-265-4000
Mailing Address - Fax:307-265-4000
Practice Address - Street 1:3211 ENERGY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-2941
Practice Address - Country:US
Practice Address - Phone:307-265-4000
Practice Address - Fax:307-265-4000
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7919101Y00000X
WYLPC 1059101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor