Provider Demographics
NPI:1740612142
Name:TRUEBLOOD, STEPHANIE JO (MA, LPC-INTERN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JO
Last Name:TRUEBLOOD
Suffix:
Gender:F
Credentials:MA, LPC-INTERN
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:JO
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3805 CATTLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3042
Mailing Address - Country:US
Mailing Address - Phone:512-809-8488
Mailing Address - Fax:
Practice Address - Street 1:3805 CATTLEMAN DR
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3042
Practice Address - Country:US
Practice Address - Phone:512-809-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health