=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902058175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEREDITH E. STEPHENS M.ED., LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2008
-----------------------------------------------------
Last Update Date | 10/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3315 FM 308
-----------------------------------------------------
City | MALONE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76660-3034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-678-9014
-----------------------------------------------------
Fax | 254-678-3550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 57
-----------------------------------------------------
City | IRENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76650-0057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-678-9014
-----------------------------------------------------
Fax | 254-678-3550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 14816
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------