Provider Demographics
NPI:1487293023
Name:FLECK, STEPHANIE (LPC, CRADC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:FLECK
Suffix:
Gender:F
Credentials:LPC, CRADC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:FLECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, CRADC
Mailing Address - Street 1:PO BOX 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4264
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017013131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional