Provider Demographics
NPI:1215213442
Name:LEON, STACY (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 EXPOSITION BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1700
Mailing Address - Country:US
Mailing Address - Phone:512-474-2488
Mailing Address - Fax:512-474-2824
Practice Address - Street 1:2630 EXPOSITION BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1700
Practice Address - Country:US
Practice Address - Phone:512-474-2488
Practice Address - Fax:512-474-2824
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ42992084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry