Provider Demographics
NPI:1316557655
Name:STOBAUGH, WESLEY DEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:DEAN
Last Name:STOBAUGH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 TWIN CREEKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-1550
Mailing Address - Country:US
Mailing Address - Phone:254-319-4565
Mailing Address - Fax:
Practice Address - Street 1:551 S IH 35 STE 200
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2820
Practice Address - Country:US
Practice Address - Phone:512-241-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX618641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty