Provider Demographics
NPI:1194733550
Name:THURSTON, STEPHANIE C (PHD, LPC-S, LSOTP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:THURSTON
Suffix:
Gender:F
Credentials:PHD, LPC-S, LSOTP
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:C
Other - Last Name:THURSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC-S, LSOTP
Mailing Address - Street 1:7 STRAIGHT CREEK CT
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5440
Mailing Address - Country:US
Mailing Address - Phone:817-916-8383
Mailing Address - Fax:817-402-2437
Practice Address - Street 1:200 PECAN CRK STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6373
Practice Address - Country:US
Practice Address - Phone:817-916-8383
Practice Address - Fax:817-402-2437
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health