Provider Demographics
NPI:1740716208
Name:FROMBERG, STACY (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:FROMBERG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 FROSTWOOD DR STE 680
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2415
Mailing Address - Country:US
Mailing Address - Phone:216-526-2881
Mailing Address - Fax:
Practice Address - Street 1:920 FROSTWOOD DR STE 680
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2415
Practice Address - Country:US
Practice Address - Phone:216-526-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional