Basic Information
| Provider Information | |||||||||
| NPI: | 1750921656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEOPOLD | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 N LORRAINE ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675015600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206637595 | ||||||||
| FaxNumber: | 6205135098 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N LORRAINE ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675015600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206637595 | ||||||||
| FaxNumber: | 6206635263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2020 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 861 | KS | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 2966 | KS | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 03048 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.