Provider Demographics
NPI:1669118303
Name:JASSO, STEPHANIE ANNETTE (MA, LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNETTE
Last Name:JASSO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:AZ
Other - Last Name:JASSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:19141 STONE OAK PKWY STE 603
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3366
Mailing Address - Country:US
Mailing Address - Phone:210-495-3131
Mailing Address - Fax:
Practice Address - Street 1:19141 STONE OAK PKWY STE 603
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3366
Practice Address - Country:US
Practice Address - Phone:210-495-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional