MEDICARE: MARILYN STEPHENS LPC

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	101YP2500X	Professional Counselor	78456

General Provider Information

NPI Number	:	1548975162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN STEPHENS LPC

Provider Business Mailing Address
First Line	:	4342 BERRY BEND LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-7224
Country	:	US
Telephone Number	:	832-801-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	10401 S MASON RD UNIT B204
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5913
Country	:	US
Telephone Number	:	832-801-0175
Fax Number	:

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

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/18/2023

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