Provider Demographics
NPI:1093270977
Name:STANLEY, ELIZABETH ERIN (LPC-S)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ERIN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ERIN
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-S
Mailing Address - Street 1:8310 EWING HALSELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3715
Mailing Address - Country:US
Mailing Address - Phone:210-616-0885
Mailing Address - Fax:210-616-0845
Practice Address - Street 1:8310 EWING HALSELL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3715
Practice Address - Country:US
Practice Address - Phone:210-616-0885
Practice Address - Fax:210-616-0845
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16002101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720147093OtherTHE ECUMENICAL CENTER FOR RELIGION AND HEALTH