Provider Demographics
NPI:1417301243
Name:STEPHEN W ELLER, PLLC
Entity Type:Organization
Organization Name:STEPHEN W ELLER, PLLC
Other - Org Name:TRUEHEARTED COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CHILDREN'S THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-237-9855
Mailing Address - Street 1:1209 SOTOGRANDE BLVD APT 122E
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-6096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5421 BASSWOOD BLVD
Practice Address - Street 2:SUITE 720
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4482
Practice Address - Country:US
Practice Address - Phone:682-237-9855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty