Provider Demographics
NPI:1528459328
Name:STEPHENSON, ELYSE MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:MARIE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:MARIE
Other - Last Name:HOXBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:8172 MALL ROAD
Mailing Address - Street 2:SUITE 219/220
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:859-282-0147
Mailing Address - Fax:859-282-9056
Practice Address - Street 1:8172 MALL ROAD
Practice Address - Street 2:SUITE 219/220
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-282-0147
Practice Address - Fax:859-282-9056
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical