Provider Demographics
NPI:1043263759
Name:STANLEY, DARRYL SCOTT (MS)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:SCOTT
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55629
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77255-5629
Mailing Address - Country:US
Mailing Address - Phone:281-960-3991
Mailing Address - Fax:713-467-6532
Practice Address - Street 1:1458 CAMPBELL ROAD
Practice Address - Street 2:STE 250A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:281-960-3991
Practice Address - Fax:713-467-6532
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMFT 5087103T00000X
TXLPC18881103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist