Provider Demographics
NPI:1942901533
Name:DAHL, STEPHANIE JOYCE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOYCE
Last Name:DAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 ANDERSON MILL RD APT 323
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-4712
Mailing Address - Country:US
Mailing Address - Phone:209-217-6242
Mailing Address - Fax:
Practice Address - Street 1:1801 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1208
Practice Address - Country:US
Practice Address - Phone:512-200-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional