MEDICARE: MRS. KATHRYN LYNN STEVENS LPC

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	101YP2500X	Professional Counselor	2017044664	MO

General Provider Information

NPI Number	:	1558863977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN LYNN STEVENS LPC

Provider Business Mailing Address
First Line	:	2011 WAKEFIELD LAKE DR
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63038-1210
Country	:	US
Telephone Number	:	314-402-8037
Fax Number	:

Provider Business Practice Location Address
First Line	:	14824 CLAYTON RD STE 23
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-7888
Country	:	US
Telephone Number	:	636-893-5224
Fax Number	:	833-619-1086

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

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	12/03/2020

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