MEDICARE: STACEY K ULRY 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	101YM0800X	Mental Health Counselor	91990	TX
2	101YP2500X	Professional Counselor	91990	TX

General Provider Information

NPI Number	:	1851170039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY K ULRY LPC

Provider Business Mailing Address
First Line	:	2631 GATTIS SCHOOL RD STE 220
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2822
Country	:	US
Telephone Number	:	512-546-7581
Fax Number	:	737-257-4848

Provider Business Practice Location Address
First Line	:	2631 GATTIS SCHOOL RD STE 220
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2822
Country	:	US
Telephone Number	:	512-546-7581
Fax Number	:	737-257-4848

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

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	01/14/2026

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