Provider Demographics
NPI:1871029843
Name:MOUTON, STEFANIE (MA, LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:MOUTON
Suffix:
Gender:F
Credentials:MA, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8314 TERRA VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5597
Mailing Address - Country:US
Mailing Address - Phone:281-376-1587
Mailing Address - Fax:
Practice Address - Street 1:17920 HUFFMEISTER RD STE 150
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6445
Practice Address - Country:US
Practice Address - Phone:832-421-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional