Provider Demographics
NPI:1346312626
Name:STEDHAM, MICHAEL JACK (LPC LMFT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JACK
Last Name:STEDHAM
Suffix:
Gender:M
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S CENTER ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7139
Mailing Address - Country:US
Mailing Address - Phone:817-276-6412
Mailing Address - Fax:817-276-6438
Practice Address - Street 1:301 S CENTER ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-7139
Practice Address - Country:US
Practice Address - Phone:817-276-6412
Practice Address - Fax:817-276-6438
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6184101YP2500X
TX2283106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0026156Medicaid