Healthcare Provider Details

I. General information

NPI: 1548322407
Provider Name (Legal Business Name): DOROTHY W STEPHENS PH.D., HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 BELLEMEADE AVE
EVANSVILLE IN
47714-0137
US

IV. Provider business mailing address

3701 BELLEMEADE AVE
EVANSVILLE IN
47714-0137
US

V. Phone/Fax

Practice location:
  • Phone: 812-479-1411
  • Fax: 812-437-2636
Mailing address:
  • Phone: 812-479-1411
  • Fax: 812-437-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010274A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0268
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20010274A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number0268
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number20010274A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number0268
License Number StateKY
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20010274A
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0268
License Number StateKY
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number20010274A
License Number StateIN
# 10
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number0268
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: