Provider Demographics
NPI:1528333564
Name:STEPHENS, JOHNA RACHAEL (MSED)
Entity type:Individual
Prefix:MS
First Name:JOHNA
Middle Name:RACHAEL
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E 25TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-5560
Mailing Address - Country:US
Mailing Address - Phone:308-627-7591
Mailing Address - Fax:
Practice Address - Street 1:409 E 25TH ST STE 3
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-5560
Practice Address - Country:US
Practice Address - Phone:308-627-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9624101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health