Healthcare Provider Details

I. General information

NPI: 1750921656
Provider Name (Legal Business Name): STEPHANIE E LEOPOLD LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N LORRAINE ST STE 202
HUTCHINSON KS
67501-5600
US

IV. Provider business mailing address

1600 N LORRAINE ST STE 202
HUTCHINSON KS
67501-5600
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-7595
  • Fax: 620-663-5263
Mailing address:
  • Phone: 620-663-7595
  • Fax: 620-513-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number861
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2966
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number03048
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: