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General NPI Number Information
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NPI Number | 1376379529
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Entity Type | Individual
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Provider Name | STACY YVONNE MARLIN PMHNP--BC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 156 S MAIN ST STE 300
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City | LUMBERTON
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State | TX
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Zip | 77657-7882
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Country | US
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Telephone | 409-449-1989
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Fax |
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Provider Business Mailing Address
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Address Line | 156 S MAIN ST STE 300
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City | LUMBERTON
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State | TX
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Zip | 77657-7882
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1179148
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2024058583
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License Number State | TX
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