Provider Demographics
NPI:1386394583
Name:DARNELL, STEPHANIE JO (BS, THW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:DARNELL
Suffix:
Gender:F
Credentials:BS, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 NE EVANS ST STE A
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4635
Mailing Address - Country:US
Mailing Address - Phone:503-472-4020
Mailing Address - Fax:503-472-8630
Practice Address - Street 1:435 NE EVANS ST STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4635
Practice Address - Country:US
Practice Address - Phone:503-472-4020
Practice Address - Fax:503-472-8630
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor