Provider Demographics
NPI:1598202715
Name:HART, STEPHANIE ETKIN (LPC-I)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ETKIN
Last Name:HART
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 BROOKLYN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4324
Mailing Address - Country:US
Mailing Address - Phone:512-534-6188
Mailing Address - Fax:
Practice Address - Street 1:2113 BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4324
Practice Address - Country:US
Practice Address - Phone:512-534-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health