Stephanie Anne Hathorn
Individual provider Active NPI Marriage & Family Therapist · Jackson, MS
NPI 1457799199 · NPPES record last updated Mar 24, 2021
Key facts
- NPI
- 1457799199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- T0465A (MS)
- Practice address
- 5422 Clinton Blvd
Jackson, MS 39209-3004 - Phone
- (601) 724-5040
- NPI assigned
- Jun 4, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1947 | MS | MD | Mental Health Counselor |
| T0465 | MS | MD | Marriage & Family Therapist |
| T0465A | MS | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hopewell Counseling | Marriage & Family Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1947 | MS | |
| Marriage & Family Therapist | 106H00000X | T0465 | MS | |
| Marriage & Family Therapist | 106H00000X | T0465A | MS | Yes |
Addresses
Primary practice location
5422 Clinton Blvd
Jackson, MS 39209-3004
Mailing address
200 Park Circle Dr Ste 1
Flowood, MS 39232-7800
Phone (601) 664-0455
Other providers in Jackson, MS
- Abbey Kate Hassell
- David Y Hastings
- Marnisha Hatch
- Arlin George Hatfield III
- Mary Hathorn
- Vicki Helene Hathorn
- Karl Hatten
- Margaret Thurber Hatten
- Hattiesburg Road Dental, P.C.
- Hattiesburg Road Dental, P.C.
All providers in Jackson, MS · Marriage & Family Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.