MEDICARE: STACY BARNES LPC, LCDC-I

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	101YM0800X	Mental Health Counselor	72345	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		TX

General Provider Information

NPI Number	:	1669954962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY BARNES LPC, LCDC-I

Provider Business Mailing Address
First Line	:	1125 GREY FOX DR
Second Line	:
City	:	SAVANNAH
State	:	TX
Zip	:	76227-7775
Country	:	US
Telephone Number	:	214-405-0537
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 COMMUNITY AVE
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-2535
Country	:	US
Telephone Number	:	725-475-2909
Fax Number	:

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

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	09/04/2018

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