Provider Demographics
NPI:1558982066
Name:BOYDSTUN, STEPHANIE D (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:BOYDSTUN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DELAINE
Other - Last Name:HARRELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79001-0158
Mailing Address - Country:US
Mailing Address - Phone:806-576-6322
Mailing Address - Fax:
Practice Address - Street 1:401 INTERSTATE 40
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:TX
Practice Address - Zip Code:79001-0158
Practice Address - Country:US
Practice Address - Phone:806-576-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health