Provider Demographics
NPI:1487027595
Name:BILLINGSLEY EZEA, STEPHANIE HOPE ALEXANDRA (LPCC-S)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HOPE ALEXANDRA
Last Name:BILLINGSLEY EZEA
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:STEPAHNIE
Other - Middle Name:
Other - Last Name:BILLINGSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:6501 GERMANTOWN RD LOT 131
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1226
Mailing Address - Country:US
Mailing Address - Phone:513-389-6009
Mailing Address - Fax:
Practice Address - Street 1:4464 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5464
Practice Address - Country:US
Practice Address - Phone:513-649-8008
Practice Address - Fax:513-649-8004
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA080412101YA0400X
OHE0800287101YM0800X
OHE.0800287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0074861OtherMEDICAID-ODADAS
OH01-0693OtherCARF CERTIFICATION
OHH130910OtherMEDICARE GROUP PTAN
OH0074946OtherMEDICAID-ODMH