Provider Demographics
NPI:1538996988
Name:HELTON, STEPHANIE MICHELL (LCDC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELL
Last Name:HELTON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:MICHELL
Other - Last Name:MAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1768 COUNTY ROAD 313
Mailing Address - Street 2:
Mailing Address - City:LOUISE
Mailing Address - State:TX
Mailing Address - Zip Code:77455-4081
Mailing Address - Country:US
Mailing Address - Phone:979-541-9097
Mailing Address - Fax:
Practice Address - Street 1:1768 COUNTY ROAD 313
Practice Address - Street 2:
Practice Address - City:LOUISE
Practice Address - State:TX
Practice Address - Zip Code:77455-4081
Practice Address - Country:US
Practice Address - Phone:979-541-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)