MEDICARE: CANDACE IRENE GUILLORY STEPHENS MS, LMHC, ATR

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	101YM0800X	Mental Health Counselor	39003470A	IN

General Provider Information

NPI Number	:	1538405816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE IRENE GUILLORY STEPHENS MS, LMHC, ATR

Provider Business Mailing Address
First Line	:	3747 RIVERWOOD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-4030
Country	:	US
Telephone Number	:	850-320-4110
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 INDIANA AVE FL 2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2915
Country	:	US
Telephone Number	:	317-274-2548
Fax Number	:

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

Provider Enumeration Date	:	12/14/2012
Last Update Date	:	02/01/2025

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