MEDICARE: CALEB STEPHENS LMSW, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1200	KS
2	101YM0800X	Mental Health Counselor	9328	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12740301	OTHER	KS	CAQH

General Provider Information

NPI Number	:	1518361492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB STEPHENS LMSW, LAC

Provider Business Mailing Address
First Line	:	1715 E CEDAR ST STE 115
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1791
Country	:	US
Telephone Number	:	816-977-3178
Fax Number	:	816-572-6838

Provider Business Practice Location Address
First Line	:	1715 E CEDAR ST STE 115
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1791
Country	:	US
Telephone Number	:	816-977-3178
Fax Number	:	816-572-6838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	01/07/2016

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