Provider Demographics
NPI:1073869525
Name:BANASAU, STEPHANIE FALCON (MS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:FALCON
Last Name:BANASAU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 S MASON RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2449
Mailing Address - Country:US
Mailing Address - Phone:832-312-2110
Mailing Address - Fax:281-398-2094
Practice Address - Street 1:462 S MASON RD
Practice Address - Street 2:SUITE 400
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2449
Practice Address - Country:US
Practice Address - Phone:832-312-2110
Practice Address - Fax:281-398-2094
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist