Healthcare Provider Details

I. General information

NPI: 1336019751
Provider Name (Legal Business Name): STEPHANIE HALVORSON LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 518
CEDAR RAPIDS IA
52402-3221
US

IV. Provider business mailing address

4403 1ST AVE SE STE 518
CEDAR RAPIDS IA
52402-3221
US

V. Phone/Fax

Practice location:
  • Phone: 515-570-3426
  • Fax:
Mailing address:
  • Phone: 515-570-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEPHANIE HALVORSON
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 515-570-3426