Provider Demographics
NPI:1649341751
Name:EDMONDSON, STELLA BORREGO (LCSW)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:BORREGO
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4888 LOOP CENTRAL DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2214
Mailing Address - Country:US
Mailing Address - Phone:713-346-1551
Mailing Address - Fax:713-346-1577
Practice Address - Street 1:4888 LOOP CENTRAL DR
Practice Address - Street 2:SUITE 510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2214
Practice Address - Country:US
Practice Address - Phone:713-346-1551
Practice Address - Fax:713-346-1577
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00201PMedicare ID - Type Unspecified