=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316462898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE HATAWAY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2017
-----------------------------------------------------
Last Update Date | 07/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4081 DE ZAVALA RD STE 101
-----------------------------------------------------
City | SHAVANO PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-2083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-255-3668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13622 SHADY WALK DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78231-1820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-952-8181
-----------------------------------------------------
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 | 18448
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------