Provider Demographics
NPI:1679903165
Name:WINN, STEPHANIE FRANCES (LMFT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:FRANCES
Last Name:WINN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NW 21ST AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1179
Mailing Address - Country:US
Mailing Address - Phone:503-468-6242
Mailing Address - Fax:971-266-2846
Practice Address - Street 1:325 NW 21ST AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1179
Practice Address - Country:US
Practice Address - Phone:503-468-6242
Practice Address - Fax:971-266-2846
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1201106H00000X, 106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500700164Medicaid