Individual
MR. JOHN D STEPHENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1309 CAMAS ST, BLACKFOOT, ID 83221-3060
(208) 782-0675
(208) 782-0678
Mailing address
PO BOX 903, BLACKFOOT, ID 83221-0903
(208) 782-0675
(208) 782-0678
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-26187
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806939500
—
ID
05
—
807352800
—
ID
Enumeration date
12/05/2006
Last updated
08/04/2014
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