Healthcare Provider Details

I. General information

NPI: 1568394203
Provider Name (Legal Business Name): STEPHANIE STEPHENSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 HUGH WALLIS RD S BLDG E
LAFAYETTE LA
70508-2528
US

IV. Provider business mailing address

123 DARTEZE DR
LAFAYETTE LA
70508-8112
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-8140
  • Fax:
Mailing address:
  • Phone: 337-354-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9986
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: