Healthcare Provider Details

I. General information

NPI: 1144937749
Provider Name (Legal Business Name): TAMIKO LYNNE STANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8226 DOUGLAS AVE STE 805
DALLAS TX
75225-5930
US

IV. Provider business mailing address

8226 DOUGLAS AVE STE 805
DALLAS TX
75225-5930
US

V. Phone/Fax

Practice location:
  • Phone: 972-689-8859
  • Fax: 214-373-3404
Mailing address:
  • Phone: 972-689-8859
  • Fax: 214-373-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: