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General NPI Number Information
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NPI Number | 1093002990
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Entity Type | Individual
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Provider Name | STACY MAE SUTHERLAND M.ED
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Gender | Female
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 1403 GREENWOOD DR
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City | DENTON
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State | TX
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Zip | 76209-2206
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Country | US
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Telephone | 940-765-6487
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Fax |
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Provider Business Mailing Address
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Address Line | 2404 FOWLER DR
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City | DENTON
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State | TX
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Zip | 76209-1919
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Country | US
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Telephone | 574-870-0332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 66834
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License Number State | TX
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