Provider Demographics
NPI:1710043690
Name:STEPHENS, CAROLYN M (MA, MSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MA, MSW
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 955
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:TX
Mailing Address - Zip Code:77362-0955
Mailing Address - Country:US
Mailing Address - Phone:281-333-3933
Mailing Address - Fax:281-333-0402
Practice Address - Street 1:37702 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:TX
Practice Address - Zip Code:77362-1918
Practice Address - Country:US
Practice Address - Phone:281-333-3393
Practice Address - Fax:281-333-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124711041C0700X
TX5909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095503101Medicaid