Provider Demographics
NPI:1164142303
Name:CAMPBELL-NOONEN, STACIE
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:CAMPBELL-NOONEN
Suffix:
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:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:POINTBLANK
Mailing Address - State:TX
Mailing Address - Zip Code:77364-1098
Mailing Address - Country:US
Mailing Address - Phone:832-233-3086
Mailing Address - Fax:
Practice Address - Street 1:2323 TIMBER SHADOWS DR STE B
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2028
Practice Address - Country:US
Practice Address - Phone:832-233-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88241OtherLPC ASSOCIATE LICENSE