Provider Demographics
NPI:1467921197
Name:STONE, MARY (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:GARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-INTERN
Mailing Address - Street 1:1715 FM 1626 STE 102
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3549
Mailing Address - Country:US
Mailing Address - Phone:512-280-5315
Mailing Address - Fax:512-280-5316
Practice Address - Street 1:1715 FM 1626 STE 102
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3549
Practice Address - Country:US
Practice Address - Phone:512-280-5315
Practice Address - Fax:512-280-5316
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional