Provider Demographics
NPI:1346951340
Name:ALLPHIN, STACIE RENEE (MS, LCDC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:RENEE
Last Name:ALLPHIN
Suffix:
Gender:F
Credentials:MS, LCDC
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:RENEE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28050 BURRO SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4229
Mailing Address - Country:US
Mailing Address - Phone:281-770-7779
Mailing Address - Fax:
Practice Address - Street 1:26411 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1964
Practice Address - Country:US
Practice Address - Phone:128-177-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9496101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)