Healthcare Provider Details

I. General information

NPI: 1124733589
Provider Name (Legal Business Name): DONALD LOUIS STILES LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
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

17143 COUNTY ROAD 541
LAVON TX
75166-1422
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number108467
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: