=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043039381
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE DUONG-HUGHES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2024
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2730 COUNTRY CLUB RD STE G2
-----------------------------------------------------
City | LUCAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75002-8781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-775-0835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2730 COUNTRY CLUB RD STE G2
-----------------------------------------------------
City | LUCAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75002-8781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-775-0835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 91329
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------