Provider Demographics
NPI:1275824591
Name:ROSAS, STACEY HILTS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:HILTS
Last Name:ROSAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 MOON SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6015
Mailing Address - Country:US
Mailing Address - Phone:512-587-1107
Mailing Address - Fax:866-587-1655
Practice Address - Street 1:5224 MOON SHADOW DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6015
Practice Address - Country:US
Practice Address - Phone:512-587-1107
Practice Address - Fax:866-587-1655
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical