Provider Demographics
NPI:1003009978
Name:STONE CREEK PSYCHOTHERAPY AND WELLNESS CENTER
Entity Type:Organization
Organization Name:STONE CREEK PSYCHOTHERAPY AND WELLNESS CENTER
Other - Org Name:STONE CREEK PSYCHOTHERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:APPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:281-579-0703
Mailing Address - Street 1:20915 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5548
Mailing Address - Country:US
Mailing Address - Phone:281-579-0703
Mailing Address - Fax:281-398-9719
Practice Address - Street 1:20915 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5548
Practice Address - Country:US
Practice Address - Phone:281-579-0703
Practice Address - Fax:281-398-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty