Provider Demographics
NPI:1053508309
Name:STEPHENS, GREGG ALAN (LISW-S)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:ALAN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4332
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:419-549-5670
Practice Address - Street 1:244 PADDOCK CT
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1317
Practice Address - Country:US
Practice Address - Phone:567-674-1886
Practice Address - Fax:740-362-5073
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0900336-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical