MEDICARE: STEPHANIE MARIE PUENTE MS, LPC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1801465869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE PUENTE MS, LPC-A

Provider Business Mailing Address
First Line	:	117 FOUR STAR DR
Second Line	:
City	:	ELGIN
State	:	TX
Zip	:	78621-2518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 FOREST CREEK DR UNIT 104
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6168
Country	:	US
Telephone Number	:	972-827-5390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/23/2021

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