Provider Demographics
NPI:1346718111
Name:MOUSER, STEPHANIE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:MOUSER
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 1:211 MAIN STREET
Mailing Address - Street 2:#150
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065
Mailing Address - Country:US
Mailing Address - Phone:940-293-4043
Mailing Address - Fax:
Practice Address - Street 1:211 MAIN STREET
Practice Address - Street 2:#150
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065
Practice Address - Country:US
Practice Address - Phone:940-293-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80693101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional