Healthcare Provider Details

I. General information

NPI: 1467048603
Provider Name (Legal Business Name): WHITNEY WYATT LEE STEPHENS LPC-MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7311 CLINTON HWY STE B
POWELL TN
37849-5224
US

IV. Provider business mailing address

7311 CLINTON HWY STE B
POWELL TN
37849-5224
US

V. Phone/Fax

Practice location:
  • Phone: 865-888-5818
  • Fax:
Mailing address:
  • Phone: 658-789-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6906
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: