Provider Demographics
NPI:1174835243
Name:SHAFENBERG, STACEY M (LPA)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:M
Last Name:SHAFENBERG
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 HORIZON NORTH PKWY
Mailing Address - Street 2:#1231
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-2809
Mailing Address - Country:US
Mailing Address - Phone:214-636-5919
Mailing Address - Fax:972-596-7410
Practice Address - Street 1:2415 COIT RD STE B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3758
Practice Address - Country:US
Practice Address - Phone:972-596-7229
Practice Address - Fax:972-596-7410
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health