Provider Demographics
NPI:1871728592
Name:DURAN, STEPHANIE GUADALUPE (LPA LPC-S LCP LCPC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:GUADALUPE
Last Name:DURAN
Suffix:
Gender:F
Credentials:LPA LPC-S LCP LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9814 CEDARCREST DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5412
Mailing Address - Country:US
Mailing Address - Phone:940-781-2349
Mailing Address - Fax:
Practice Address - Street 1:133 N. RIVERFRONT BLVD.
Practice Address - Street 2:8TH FLOOR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207
Practice Address - Country:US
Practice Address - Phone:214-653-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1499103TC0700X
TX34434103TF0200X
NV1224101YP2500X
TX70956101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic