Provider Demographics
NPI:1558019240
Name:CHAVEZ, STEPHANIE A (MA, LPC, LCDC-I)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MA, LPC, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11730 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-5069
Mailing Address - Country:US
Mailing Address - Phone:936-648-5596
Mailing Address - Fax:
Practice Address - Street 1:11730 ROBIN LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-5069
Practice Address - Country:US
Practice Address - Phone:936-648-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83154101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health