Provider Demographics
NPI:1275841041
Name:CARLTON, STACI E (LPC)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:E
Last Name:CARLTON
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 1:5184 W HIGHWAY 290
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8913
Mailing Address - Country:US
Mailing Address - Phone:512-953-7734
Mailing Address - Fax:
Practice Address - Street 1:5184 W HIGHWAY 290
Practice Address - Street 2:STE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8913
Practice Address - Country:US
Practice Address - Phone:512-953-7734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73521101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor