Provider Demographics
NPI:1457805384
Name:DR STEPH - WELLNESS SOLUTIONS
Entity Type:Organization
Organization Name:DR STEPH - WELLNESS SOLUTIONS
Other - Org Name:WELLNESS SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-723-0673
Mailing Address - Street 1:115 S TRAVIS ST # 303
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5990
Mailing Address - Country:US
Mailing Address - Phone:254-723-0673
Mailing Address - Fax:254-723-0673
Practice Address - Street 1:706 W PELTON ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2946
Practice Address - Country:US
Practice Address - Phone:254-723-0673
Practice Address - Fax:254-723-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851697130OtherINDIVIDUAL NPI