Provider Demographics
NPI:1275661522
Name:PASKVAN, STACY KAY (LPC, LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:KAY
Last Name:PASKVAN
Suffix:
Gender:F
Credentials:LPC, LMFTA
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:KAY
Other - Last Name:RAWLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5641 DUSEOBOC
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6168
Mailing Address - Country:US
Mailing Address - Phone:361-728-3417
Mailing Address - Fax:361-853-2502
Practice Address - Street 1:4949 EVERHART RD
Practice Address - Street 2:STE 104
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3949
Practice Address - Country:US
Practice Address - Phone:361-853-0091
Practice Address - Fax:361-853-2502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62092101YP2500X
TX201018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist