Healthcare Provider Details

I. General information

NPI: 1629725254
Provider Name (Legal Business Name): MAGGIE STEPHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SOUTHTOWN DR STE 106
GRANBURY TX
76048-2667
US

IV. Provider business mailing address

PO BOX 121835
ARLINGTON TX
76012-7835
US

V. Phone/Fax

Practice location:
  • Phone: 855-579-5323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: