Provider Demographics
NPI:1326663907
Name:MCEWIN, STACE LYNN (LPC)
Entity Type:Individual
Prefix:MR
First Name:STACE
Middle Name:LYNN
Last Name:MCEWIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BOBWHITE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY LAKE RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75765-7200
Mailing Address - Country:US
Mailing Address - Phone:806-789-4101
Mailing Address - Fax:
Practice Address - Street 1:124 BOBWHITE LN
Practice Address - Street 2:
Practice Address - City:HOLLY LAKE RANCH
Practice Address - State:TX
Practice Address - Zip Code:75765-7200
Practice Address - Country:US
Practice Address - Phone:806-789-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional