Provider Demographics
NPI:1275066946
Name:LAFAYETTE-HOUSTON, STEPHANIE FAITH
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:FAITH
Last Name:LAFAYETTE-HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-4914
Mailing Address - Country:US
Mailing Address - Phone:318-834-8120
Mailing Address - Fax:
Practice Address - Street 1:5915 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-4914
Practice Address - Country:US
Practice Address - Phone:318-834-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health