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General NPI Number Information
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NPI Number | 1144879685
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Entity Type | Individual
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Provider Name | STEPHANIE GAYLE DONNELL LPC
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Gender | Female
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Dates
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Enumeration Date | 09/07/2019
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 2307 SMISER ST
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City | BUSHLAND
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State | TX
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Zip | 79124-1198
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Country | US
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Telephone | 806-318-8054
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Fax | 806-322-1166
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Provider Business Mailing Address
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Address Line | PO BOX 521
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City | BUSHLAND
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State | TX
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Zip | 79012-0521
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Country | US
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Telephone | 806-673-8565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 78919
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License Number State | TX
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