Healthcare Provider Details

I. General information

NPI: 1154876621
Provider Name (Legal Business Name): STEPHANIE MANION PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 HORIZON CT STE 220
GRAND JUNCTION CO
81506-8716
US

IV. Provider business mailing address

743 HORIZON CT STE 220
GRAND JUNCTION CO
81506-8716
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax: 888-965-4615
Mailing address:
  • Phone: 970-310-3406
  • Fax: 888-965-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0006090
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: