Provider Demographics
NPI:1457436610
Name:JEFFRIES, STEPHANIE PAGE (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PAGE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:PAGE
Other - Last Name:JEFFRIES-WEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 2692
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-2692
Mailing Address - Country:US
Mailing Address - Phone:512-658-5438
Mailing Address - Fax:512-866-9143
Practice Address - Street 1:3003 DAWN DR STE 108
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2800
Practice Address - Country:US
Practice Address - Phone:512-658-5438
Practice Address - Fax:512-863-9143
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0282642/01Medicaid