Provider Demographics
NPI:1710170162
Name:TRIANA, STEPHANIE (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TRIANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21015 LA PENA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2935
Mailing Address - Country:US
Mailing Address - Phone:210-346-0775
Mailing Address - Fax:210-775-0088
Practice Address - Street 1:1848 LOCKHILL SELMA RD
Practice Address - Street 2:STE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1566
Practice Address - Country:US
Practice Address - Phone:210-346-0775
Practice Address - Fax:210-775-0088
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36505103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral