MEDICARE: SHAUNDRA STEPHENS CMLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1528940558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNDRA STEPHENS CMLC

Provider Business Mailing Address
First Line	:	3921 FRESHFIELD RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-2111
Country	:	US
Telephone Number	:	682-325-2055
Fax Number	:

Provider Business Practice Location Address
First Line	:	9008 STONE MILL LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-8118
Country	:	US
Telephone Number	:	682-325-2055
Fax Number	:

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

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	12/04/2025

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Directions to “ SHAUNDRA STEPHENS CMLC” Practice Location

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