Provider Demographics
NPI:1376213306
Name:PRILLAMAN, STACEY LEE (LPC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEE
Last Name:PRILLAMAN
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 1:1502 SHERRY DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-5185
Mailing Address - Country:US
Mailing Address - Phone:512-663-7537
Mailing Address - Fax:
Practice Address - Street 1:1502 SHERRY DR
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-5185
Practice Address - Country:US
Practice Address - Phone:512-663-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional