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General NPI Number Information
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NPI Number | 1578824330
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Entity Type | Organization
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Legal Business Name | STEPHENS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 3829 WASHBURN AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55410-1129
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Country | US
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Telephone | 612-251-7413
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Fax | 612-927-7425
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Provider Business Mailing Address
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Address Line | 3829 WASHBURN AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55410-1129
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Country | US
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Telephone | 612-251-7413
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Fax | 612-927-7425
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROL M STEPHENS
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Credential | PSY. D, LP
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Telephone | 612-251-7413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3384
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License Number State | MN
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