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General NPI Number Information
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NPI Number | 1457805384
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Entity Type | Organization
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Legal Business Name | DR STEPH - WELLNESS SOLUTIONS
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 706 W PELTON ST
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City | SHERMAN
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State | TX
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Zip | 75092-2946
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Country | US
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Telephone | 254-723-0673
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Fax | 254-723-0673
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Provider Business Mailing Address
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Address Line | 115 S TRAVIS ST # 303
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City | SHERMAN
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State | TX
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Zip | 75090-5990
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Country | US
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Telephone | 254-723-0673
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Fax | 254-723-0673
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE L WAITT
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Credential | PHD
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Telephone | 254-723-0673
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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 | 62794
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License Number State | TX
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