Provider Demographics
NPI:1275131559
Name:STUARD, DEBBIE JO (LCDC MA)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:JO
Last Name:STUARD
Suffix:
Gender:F
Credentials:LCDC MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 1ST ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2472
Mailing Address - Country:US
Mailing Address - Phone:713-462-6565
Mailing Address - Fax:
Practice Address - Street 1:1615 HILLENDAHL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3416
Practice Address - Country:US
Practice Address - Phone:713-462-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12689101YA0400X
101YA0400X, 175T00000X, 261QF0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX628Medicaid