Provider Demographics
NPI:1871544734
Name:STEBBINS, DAVID W (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:STEBBINS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BROOKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75803-5514
Mailing Address - Country:US
Mailing Address - Phone:903-391-7881
Mailing Address - Fax:903-723-1762
Practice Address - Street 1:1111 W LACY ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8149
Practice Address - Country:US
Practice Address - Phone:903-391-7881
Practice Address - Fax:903-723-1762
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15807101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3875LCOtherBLUE CROSS BLUE SHIELD