MEDICARE: LINDSEY J STANLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	104945	TX

General Provider Information

NPI Number	:	1356102321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY J STANLEY LCSW

Provider Business Mailing Address
First Line	:	610 S JENNINGS AVE STE C
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3209
Country	:	US
Telephone Number	:	682-702-8938
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 S JENNINGS AVE STE C
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3209
Country	:	US
Telephone Number	:	682-702-8938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	01/17/2024

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