MEDICARE: MS. STACI E CARLTON 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	101Y00000X	Counselor	73521	TX

General Provider Information

NPI Number	:	1275841041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACI E CARLTON LPC

Provider Business Mailing Address
First Line	:	5184 W HIGHWAY 290
Second Line	:	STE A
City	:	AUSTIN
State	:	TX
Zip	:	78735-8913
Country	:	US
Telephone Number	:	512-953-7734
Fax Number	:

Provider Business Practice Location Address
First Line	:	5184 W HIGHWAY 290
Second Line	:	STE A
City	:	AUSTIN
State	:	TX
Zip	:	78735-8913
Country	:	US
Telephone Number	:	512-953-7734
Fax Number	:

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	04/03/2017

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