Provider Demographics
NPI:1285819581
Name:BRIGNAC, STACY SHOOK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:SHOOK
Last Name:BRIGNAC
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 1:13253 WOODED ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BREMOND
Mailing Address - State:TX
Mailing Address - Zip Code:76629-5237
Mailing Address - Country:US
Mailing Address - Phone:254-297-3557
Mailing Address - Fax:254-297-5346
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:254-297-3557
Practice Address - Fax:254-297-5346
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX293901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical