Provider Demographics
NPI:1871734822
Name:CLASSEN, STEPHANIE RENAE (MS LMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENAE
Last Name:CLASSEN
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8443
Mailing Address - Country:US
Mailing Address - Phone:254-498-0998
Mailing Address - Fax:
Practice Address - Street 1:9516 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8443
Practice Address - Country:US
Practice Address - Phone:254-498-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist