Basic Information
| Provider Information | |||||||||
| NPI: | 1538145537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLOPFER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MED, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 MAC BLVD | ||||||||
| Address2: | |||||||||
| City: | NEVADA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647723990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176672262 | ||||||||
| FaxNumber: | 4176676515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 COMMUNITY | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647358804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608908183 | ||||||||
| FaxNumber: | 8163183109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 05/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2000169031 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 454695 | 01 | HEALTHLINK | OTHER | 6082C10 | 01 | BLUE CROSS | OTHER | 499087609 | 05 | MO | MEDICAID |