Provider Demographics
NPI:1871029843
Name:MOUTON, STEFANIE BATES (MA, LPC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:BATES
Last Name:MOUTON
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 1:8725 BURDEKIN RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4581
Mailing Address - Country:US
Mailing Address - Phone:281-770-1858
Mailing Address - Fax:
Practice Address - Street 1:8725 BURDEKIN RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4581
Practice Address - Country:US
Practice Address - Phone:281-770-1858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional