Provider Demographics
NPI:1770729139
Name:DEFREITAS, STACIE CRAFT (LP, PHD)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:CRAFT
Last Name:DEFREITAS
Suffix:
Gender:F
Credentials:LP, PHD
Other - Prefix:DR
Other - First Name:STACIE
Other - Middle Name:ANN
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1714 BIG HORN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1865
Mailing Address - Country:US
Mailing Address - Phone:281-979-8249
Mailing Address - Fax:
Practice Address - Street 1:128 VISION PARK BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3018
Practice Address - Country:US
Practice Address - Phone:832-346-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70244103TS0200X
TX35210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool