Provider Demographics
NPI:1578002390
Name:PASSMORE, STEPHANIE (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:PASSMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1125 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4440
Mailing Address - Country:US
Mailing Address - Phone:360-672-2182
Mailing Address - Fax:
Practice Address - Street 1:5300 TOWN AND COUNTRY BLVD STE 240
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1008
Practice Address - Country:US
Practice Address - Phone:360-672-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61280846101YM0800X
TX92301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health