Provider Demographics
NPI:1144879685
Name:DONNELL, STEPHANIE GAYLE (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GAYLE
Last Name:DONNELL
Suffix:
Gender:F
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:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:BUSHLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79012-0521
Mailing Address - Country:US
Mailing Address - Phone:806-673-8565
Mailing Address - Fax:
Practice Address - Street 1:2307 SMISER ST
Practice Address - Street 2:
Practice Address - City:BUSHLAND
Practice Address - State:TX
Practice Address - Zip Code:79124-1198
Practice Address - Country:US
Practice Address - Phone:806-318-8054
Practice Address - Fax:806-322-1166
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional