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General NPI Number Information
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NPI Number | 1457021040
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Entity Type | Individual
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Provider Name | STEPHANIE PATAK LPC ASSOCIATE
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 12800 HILLCREST RD STE A103
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City | DALLAS
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State | TX
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Zip | 75230-1524
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Country | US
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Telephone | 972-825-6570
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Fax |
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Provider Business Mailing Address
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Address Line | 3114 CAMBRIDGE DR
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City | ROWLETT
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State | TX
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Zip | 75088-5911
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Country | US
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Telephone | 817-219-9094
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 86969
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License Number State | TX
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