Provider Demographics
NPI:1912501206
Name:PEREZ, STEPHANIE RUBY (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RUBY
Last Name:PEREZ
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RUBY
Other - Last Name:LOERA-OLAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1413 SILO RD APT 702
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2886
Mailing Address - Country:US
Mailing Address - Phone:469-247-5578
Mailing Address - Fax:
Practice Address - Street 1:1413 SILO RD APT 702
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2886
Practice Address - Country:US
Practice Address - Phone:469-247-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health