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General NPI Number Information
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NPI Number | 1174072581
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Entity Type | Individual
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Provider Name | STEPHANIE BANUELOS PHD
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Gender | Female
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 3006 BEE CAVES RD STE D310
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City | ROLLINGWOOD
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State | TX
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Zip | 78746-5753
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Country | US
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Telephone | 512-956-4011
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Fax |
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Provider Business Mailing Address
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Address Line | 8003 S IH 35 APT 2724
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City | AUSTIN
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State | TX
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Zip | 78744-0089
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Country | US
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Telephone | 562-212-3944
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 39141
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 39141
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License Number State | TX
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