Provider Demographics
NPI:1952158214
Name:STONE, LORISSA R (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:LORISSA
Middle Name:R
Last Name:STONE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40502 BERYLLINE LN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-7071
Mailing Address - Country:US
Mailing Address - Phone:936-236-2083
Mailing Address - Fax:
Practice Address - Street 1:506 HONEA EGYPT RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2568
Practice Address - Country:US
Practice Address - Phone:936-236-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional