Provider Demographics
NPI:1932479169
Name:HARABURDA, STEPHANIE (MED, LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HARABURDA
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 W HEBRON PKWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6345
Mailing Address - Country:US
Mailing Address - Phone:972-836-8051
Mailing Address - Fax:
Practice Address - Street 1:1428 W HEBRON PKWY
Practice Address - Street 2:SUITE 135
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6345
Practice Address - Country:US
Practice Address - Phone:972-836-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health