Healthcare Provider Details

I. General information

NPI: 1497908602
Provider Name (Legal Business Name): STACY TEMPLETON DAVIS PSYD, MP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 08/02/2024
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W PINHOOK RD STE 504
LAFAYETTE LA
70508-3212
US

IV. Provider business mailing address

2020 W PINHOOK RD STE 504
LAFAYETTE LA
70508-3212
US

V. Phone/Fax

Practice location:
  • Phone: 337-593-0830
  • Fax:
Mailing address:
  • Phone: 630-747-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1073
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1073
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number339669
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: