MEDICARE: STEPHANIE ANN STERNES LCPC, LAMFT, NCC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LCPC-7165	ID
2	101YP2500X	Professional Counselor	SUPERVISOR	ID
3	106H00000X	Marriage & Family Therapist	LAMFT-6458	ID
4	172V00000X	Community Health Worker	LCPC-7165	ID
5	101YP2500X	Professional Counselor	LCPC-7165	ID

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1316373301	OTHER	ID	THE COMPANY I WORK FORS NPI IS 1316373301
2	463685355	OTHER		THE TAX ID FOR THE COMPANY I WORK FOR IS 463685355
3	1568933521	OTHER	ID	A COMPANY THAT I WORK FORR

NPI Number	:	1003368358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ANN STERNES LCPC, LAMFT, NCC

Provider Business Mailing Address
First Line	:	8611 DEWEY RD
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-8855
Country	:	US
Telephone Number	:	208-369-3724
Fax Number	:	844-696-1471

Provider Business Practice Location Address
First Line	:	1016 E LOCUST ST
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-2776
Country	:	US
Telephone Number	:	208-918-0054
Fax Number	:	844-696-1471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2016
Last Update Date	:	01/04/2019

1016 E LOCUST ST
EMMETT, ID
83617-2776

Practice Phone: 208-365-3584
Practice Fax: 208-365-2471