Provider Demographics
NPI:1093591877
Name:DAVIS, STEPHANIE LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S BOIS D ARC ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050-2221
Mailing Address - Country:US
Mailing Address - Phone:254-266-0386
Mailing Address - Fax:
Practice Address - Street 1:1014 FERRIS AVE, SUITE 1047
Practice Address - Street 2:FERRIS PLAZA, SUITE 1047
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2590
Practice Address - Country:US
Practice Address - Phone:817-357-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional