Provider Demographics
NPI:1477721017
Name:STAMPER, MICHEL R (LPC)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:R
Last Name:STAMPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16963 INTERSTATE 45 N
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-7065
Mailing Address - Country:US
Mailing Address - Phone:832-790-4642
Mailing Address - Fax:281-419-1811
Practice Address - Street 1:704 N THOMPSON ST STE 190
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2579
Practice Address - Country:US
Practice Address - Phone:832-790-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health