Healthcare Provider Details

I. General information

NPI: 1205263951
Provider Name (Legal Business Name): STACY RAE VOLLANDS MS, MS, LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MASON ST
TOMBALL TX
77375-4450
US

IV. Provider business mailing address

1302 LAMBOURNE CIRCLE
SPRING TX
77379
US

V. Phone/Fax

Practice location:
  • Phone: 281-255-9922
  • Fax: 281-255-9064
Mailing address:
  • Phone: 281-251-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number71825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: