Provider Demographics
NPI:1386051910
Name:CRUZ-TREVINO, STEPHANIE DENISE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DENISE
Last Name:CRUZ-TREVINO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-4020
Mailing Address - Country:US
Mailing Address - Phone:512-705-7990
Mailing Address - Fax:
Practice Address - Street 1:813 W 11TH ST
Practice Address - Street 2:A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2057
Practice Address - Country:US
Practice Address - Phone:512-705-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health