MEDICARE: MRS. PATRICIA LEE STAHL 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	000563	TX

General Provider Information

NPI Number	:	1659507655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA LEE STAHL LCSW

Provider Business Mailing Address
First Line	:	3100 CARLISLE ST
Second Line	:	#108
City	:	DALLAS
State	:	TX
Zip	:	75204-1358
Country	:	US
Telephone Number	:	214-724-6696
Fax Number	:	214-939-5214

Provider Business Practice Location Address
First Line	:	3100 CARLISLE ST
Second Line	:	#108
City	:	DALLAS
State	:	TX
Zip	:	75204-1358
Country	:	US
Telephone Number	:	214-724-6696
Fax Number	:	214-939-5214

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

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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