Provider Demographics
NPI:1073765004
Name:FESUK, STEPHEN BORIS JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BORIS
Last Name:FESUK
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-4726
Mailing Address - Country:US
Mailing Address - Phone:254-526-4146
Mailing Address - Fax:254-526-9351
Practice Address - Street 1:100 E AVENUE A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-4763
Practice Address - Country:US
Practice Address - Phone:254-526-4146
Practice Address - Fax:254-526-9351
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist