Provider Demographics
NPI:1922706027
Name:FISTER, STEPHANIE L (LPCA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:FISTER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 BAYSWATER DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7182
Mailing Address - Country:US
Mailing Address - Phone:859-409-8115
Mailing Address - Fax:
Practice Address - Street 1:1655 BURLINGTON PIKE STE 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4909
Practice Address - Country:US
Practice Address - Phone:859-342-6444
Practice Address - Fax:859-342-0999
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY279811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY279811OtherCOUNSELING LICENSE NUMBER