MEDICARE: WESLEY DEAN STOBAUGH LCSW

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	1041C0700X	Clinical Social Worker	61864	TX

General Provider Information

NPI Number	:	1316557655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY DEAN STOBAUGH LCSW

Provider Business Mailing Address
First Line	:	116 TWIN CREEKVIEW LN
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-1550
Country	:	US
Telephone Number	:	254-319-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 S IH 35 STE 200
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2820
Country	:	US
Telephone Number	:	512-241-7314
Fax Number	:

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

Provider Enumeration Date	:	08/02/2020
Last Update Date	:	06/05/2023

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