Provider Demographics
NPI:1457021040
Name:PATAK, STEPHANIE (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PATAK
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5911
Mailing Address - Country:US
Mailing Address - Phone:817-219-9094
Mailing Address - Fax:
Practice Address - Street 1:12800 HILLCREST RD STE A103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1524
Practice Address - Country:US
Practice Address - Phone:972-825-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86969101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty