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General NPI Number Information
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NPI Number | 1396112322
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Entity Type | Individual
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Provider Name | CAROL STALCUP PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 6421 CAMP BOWIE BLVD SUITE 306
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City | FORT WORTH
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State | TX
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Zip | 76116-5401
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Country | US
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Telephone | 817-732-7748
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Fax |
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Provider Business Mailing Address
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Address Line | 6421 CAMP BOWIE BLVD SUITE 306
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City | FORT WORTH
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State | TX
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Zip | 76116-5401
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Country | US
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Telephone | 817-732-7748
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2-2451
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License Number State | TX
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