Provider Demographics
NPI:1679345136
Name:STEPHAN, THOMAS DYER JR (LMFT-A)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DYER
Last Name:STEPHAN
Suffix:JR
Gender:M
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 PAYTON FALLS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5814
Mailing Address - Country:US
Mailing Address - Phone:512-588-2792
Mailing Address - Fax:
Practice Address - Street 1:1101 SATELLITE VW UNIT 603
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1592
Practice Address - Country:US
Practice Address - Phone:512-993-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist