Provider Demographics
NPI:1790250298
Name:STEPHENSON, PAUL R (LPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 JACKSON KELLER RD STE 329
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2723
Mailing Address - Country:US
Mailing Address - Phone:210-912-5298
Mailing Address - Fax:
Practice Address - Street 1:3701 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3611
Practice Address - Country:US
Practice Address - Phone:210-434-0531
Practice Address - Fax:210-434-0321
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional