Provider Demographics
NPI:1609510197
Name:STOLTE, CLARISSA RAYANN (LPC)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:RAYANN
Last Name:STOLTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:RAYANN
Other - Last Name:BROTHERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11372 W HWY 90 LOT 22
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3430
Mailing Address - Country:US
Mailing Address - Phone:432-386-7057
Mailing Address - Fax:
Practice Address - Street 1:11372 W HWY 90 LOT 22
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3430
Practice Address - Country:US
Practice Address - Phone:432-386-7057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty