Healthcare Provider Details

I. General information

NPI: 1275701526
Provider Name (Legal Business Name): STEPHEN STIPE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1852 NORWOOD PLZ STE 101
HURST TX
76054-3753
US

IV. Provider business mailing address

1852 NORWOOD PLZ STE 101
HURST TX
76054-3753
US

V. Phone/Fax

Practice location:
  • Phone: 817-282-3323
  • Fax: 817-282-6128
Mailing address:
  • Phone: 817-282-3323
  • Fax: 817-282-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16227
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16227
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number16227
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16227
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16227
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number16227
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: