Provider Demographics
NPI:1205015294
Name:TUBBS, STANLEY IVON JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:IVON
Last Name:TUBBS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 BRANARD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5015
Mailing Address - Country:US
Mailing Address - Phone:713-529-0037
Mailing Address - Fax:713-529-0498
Practice Address - Street 1:401 BRANARD ST FL 2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5015
Practice Address - Country:US
Practice Address - Phone:713-529-0037
Practice Address - Fax:713-529-0498
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX085371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142892202Medicaid