Provider Demographics
NPI:1447095369
Name:MATOS, STEPHANIE INES (LPC-A)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:INES
Last Name:MATOS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4406
Mailing Address - Country:US
Mailing Address - Phone:281-342-4530
Mailing Address - Fax:
Practice Address - Street 1:400 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4406
Practice Address - Country:US
Practice Address - Phone:281-342-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional