Provider Demographics
NPI:1396248118
Name:NUNN, STEPHENIE PENDER (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:PENDER
Last Name:NUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHENIE
Other - Middle Name:PENDER
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3012 SW 26TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3161
Mailing Address - Country:US
Mailing Address - Phone:806-567-8378
Mailing Address - Fax:
Practice Address - Street 1:3012 SW 26TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3161
Practice Address - Country:US
Practice Address - Phone:806-567-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-18
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX609161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical