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General NPI Number Information
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NPI Number | 1043507247
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Entity Type | Organization
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Legal Business Name | STACEY HEAD
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 814 E ABRAM ST SUITE A
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City | ARLINGTON
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State | TX
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Zip | 76010-1242
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Country | US
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Telephone | 512-632-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 7819 CORONA CT
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City | ARLINGTON
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State | TX
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Zip | 76002-4787
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Country | US
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Telephone | 512-632-3008
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STACEY HEAD
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Credential | LPC
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Telephone | 512-632-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 63059
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License Number State | TX
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