Individual
JACQUALENE J. STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3310 LIVE OAK ST, BEHAVIORAL HEALTH & SOCIAL SERVICES, DALLAS, TX 75204-6153
(214) 266-1222
(214) 266-1248
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2-3002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149400701
—
TX
05
—
149400702
—
TX
05
—
149400703
—
TX
05
—
149400704
—
TX
05
—
149400705
—
TX
05
—
149400706
—
TX
05
—
149400707
—
TX
05
—
149400708
—
TX
05
—
149400709
—
TX
05
—
149400710
—
TX
05
—
149400711
—
TX
05
—
149400712
—
TX
01
—
81457P
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/08/2005
Last updated
09/03/2009
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