Provider Demographics
NPI:1588732598
Name:STEPHENS, CAROL MARGARET (LP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARGARET
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3400
Mailing Address - Country:US
Mailing Address - Phone:952-835-1311
Mailing Address - Fax:
Practice Address - Street 1:7500 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-3400
Practice Address - Country:US
Practice Address - Phone:952-835-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800002580OtherRR MEDICARE
MNHP19366OtherHEALTHPARTNERS
MN638257600Medicaid
MN411425197OtherCIGNA BEHAVIORAL HEALTH
MN6100406OtherMEDICA CHOICE
MN108932C154OtherUCARE
MN6H116STOtherBCBS
MN411425197OtherCIGNA BEHAVIORAL HEALTH