Provider Demographics
NPI:1386319457
Name:DURHAM, STEPHANIE DIANE (LPC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DIANE
Last Name:DURHAM
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 1:1112 SUNSET BAY DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1240
Mailing Address - Country:US
Mailing Address - Phone:254-913-7229
Mailing Address - Fax:
Practice Address - Street 1:1112 SUNSET BAY DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1240
Practice Address - Country:US
Practice Address - Phone:254-913-7229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80725101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional