Provider Demographics
NPI:1689250599
Name:STEPHENS, MARY DAWN (LCDC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DAWN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 TULLY RD STE R&S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5435
Mailing Address - Country:US
Mailing Address - Phone:183-289-2308
Mailing Address - Fax:
Practice Address - Street 1:800 TULLY RD STE R&S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5435
Practice Address - Country:US
Practice Address - Phone:183-289-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10811101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)