Provider Demographics
NPI:1053458372
Name:HALL, STACEY II
Entity Type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:
Last Name:HALL
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8526 MORNING OAK LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1499
Mailing Address - Country:US
Mailing Address - Phone:832-683-4247
Mailing Address - Fax:832-683-4247
Practice Address - Street 1:8526 MORNING OAK LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1499
Practice Address - Country:US
Practice Address - Phone:832-683-4247
Practice Address - Fax:832-683-4247
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37143171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator