MEDICARE: ELIZABETH CLARK STEPHENSON LCPC

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	LPC-6179	ID
2	101YM0800X	Mental Health Counselor	LCPC-7104	ID

General Provider Information

NPI Number	:	1932653870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CLARK STEPHENSON LCPC

Provider Business Mailing Address
First Line	:	342 W 1ST S APT 101
Second Line	:
City	:	REXBURG
State	:	ID
Zip	:	83440-5133
Country	:	US
Telephone Number	:	208-671-1537
Fax Number	:

Provider Business Practice Location Address
First Line	:	859 S YELLOWSTONE HWY # 2201
Second Line	:
City	:	REXBURG
State	:	ID
Zip	:	83440-5293
Country	:	US
Telephone Number	:	208-649-8300
Fax Number	:

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	10/22/2025

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