Provider Demographics
NPI:1417965815
Name:CLAVENNA, STEPHANIE GARLAND (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:GARLAND
Last Name:CLAVENNA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5632
Mailing Address - Country:US
Mailing Address - Phone:210-837-5046
Mailing Address - Fax:
Practice Address - Street 1:661 INDIAN CREEK DR
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5632
Practice Address - Country:US
Practice Address - Phone:210-837-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85343106H00000X
TX202840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist