Healthcare Provider Details

I. General information

NPI: 1366830325
Provider Name (Legal Business Name): KAELA STEPHENS LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 CLOVIS AVE
CLOVIS CA
93612-1115
US

IV. Provider business mailing address

PO BOX 1774
CLOVIS CA
93613-1774
US

V. Phone/Fax

Practice location:
  • Phone: 559-475-8202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCC7488
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC7488
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC7488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: