Provider Demographics
NPI:1548906761
Name:BLASS, STEPHANIE NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:BLASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:N
Other - Last Name:BLASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1417 BEN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7815
Mailing Address - Country:US
Mailing Address - Phone:817-845-2746
Mailing Address - Fax:
Practice Address - Street 1:1417 BEN DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7815
Practice Address - Country:US
Practice Address - Phone:817-845-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical