Provider Demographics
NPI:1275058612
Name:ROLLER, STEFFANI LYNNE (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:STEFFANI
Middle Name:LYNNE
Last Name:ROLLER
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:STEFFLAN
Other - Middle Name:
Other - Last Name:WILLEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8504 CAPITOL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-5400
Mailing Address - Country:US
Mailing Address - Phone:134-081-8177
Mailing Address - Fax:877-894-5104
Practice Address - Street 1:4422 PACK SADDLE PASS STE 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1644
Practice Address - Country:US
Practice Address - Phone:713-408-1817
Practice Address - Fax:877-894-5104
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13451101YA0400X
TX76357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13451OtherLCDC LICENSE
TX76357OtherLPC LICENSE