MEDICARE: TIMOTHY R. STACEY 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	65902	TX

General Provider Information

NPI Number	:	1750639464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY R. STACEY LPC

Provider Business Mailing Address
First Line	:	6812 WALKUP LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-3945
Country	:	US
Telephone Number	:	512-791-0293
Fax Number	:

Provider Business Practice Location Address
First Line	:	6812 WALKUP LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-3945
Country	:	US
Telephone Number	:	512-791-0293
Fax Number	:

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

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	01/23/2025

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