Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 16227 | TX |
N | 101YM0800X | Mental Health Counselor | 16227 | TX |
N | 101YP1600X | Pastoral Counselor | 16227 | TX |
N | 101YP2500X | Professional Counselor | 16227 | TX |
Y | 1041C0700X | Clinical Social Worker | 16227 | TX |
NPI | 1275701526 |
---|---|
Provider Name | Mr. Stephen Stipe |
First Address | Hurst, TX 76054-3753 |
Second Address | Hurst, TX 76054-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2008 |
Last Update Date | 20/02/2008 |