Healthcare Provider Details

I. General information

NPI: 1194939108
Provider Name (Legal Business Name): STACY ZUGG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY ZUGG LCSW

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 DELANO AVE
MIDLAND TX
79701-6357
US

IV. Provider business mailing address

PO BOX 5576
MIDLAND TX
79704-5576
US

V. Phone/Fax

Practice location:
  • Phone: 432-697-4747
  • Fax: 432-699-3813
Mailing address:
  • Phone: 432-570-0238
  • Fax: 432-699-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21334
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: