Healthcare Provider Details

I. General information

NPI: 1922277516
Provider Name (Legal Business Name): STACY WUNSCH L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9595 SIX PINES DR BLDG 8L2 STE 8210
THE WOODLANDS TX
77380-1531
US

IV. Provider business mailing address

9595 SIX PINES DR BLDG 8L2 STE 8210
THE WOODLANDS TX
77380-1531
US

V. Phone/Fax

Practice location:
  • Phone: 832-631-6112
  • Fax:
Mailing address:
  • Phone: 832-631-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00941
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: