Provider Demographics
NPI:1235883042
Name:BRUNET, STACI (LPC)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:BRUNET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1701
Mailing Address - Country:US
Mailing Address - Phone:985-772-1579
Mailing Address - Fax:
Practice Address - Street 1:5206 3RD ST STE B
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2112
Practice Address - Country:US
Practice Address - Phone:832-934-9036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health