Healthcare Provider Details

I. General information

NPI: 1033681887
Provider Name (Legal Business Name): STACEY OGDEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W MOCKINGBIRD LN STE 105
DALLAS TX
75247-4936
US

IV. Provider business mailing address

3417 CRICKET DR
DENTON TX
76207-1730
US

V. Phone/Fax

Practice location:
  • Phone: 469-983-1300
  • Fax:
Mailing address:
  • Phone: 214-636-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number80150
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: