MEDICARE: STAN E STANLEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	19218	TX

General Provider Information

NPI Number	:	1154507044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STAN E STANLEY LPC

Provider Business Mailing Address
First Line	:	4902 WING RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1624
Country	:	US
Telephone Number	:	512-964-7301
Fax Number	:	512-382-1966

Provider Business Practice Location Address
First Line	:	4902 WING RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1624
Country	:	US
Telephone Number	:	512-964-7301
Fax Number	:	512-382-1966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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Directions to “ STAN E STANLEY LPC” Practice Location

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