Provider Demographics
NPI:1386118479
Name:STOBAUGH, JAMI (LPC)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:STOBAUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 INDIAN CAMP TRL
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-3983
Mailing Address - Country:US
Mailing Address - Phone:254-291-8796
Mailing Address - Fax:
Practice Address - Street 1:1907 INDIAN CAMP TRL
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3983
Practice Address - Country:US
Practice Address - Phone:254-291-8796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional