Provider Demographics
NPI:1376811513
Name:COVINGTON, STACY L (MA; LPC;LCDC-I)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:L
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:MA; LPC;LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 TWILIGHT MESA DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-3525
Mailing Address - Country:US
Mailing Address - Phone:512-626-6217
Mailing Address - Fax:
Practice Address - Street 1:7204 TWILIGHT MESA DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-3525
Practice Address - Country:US
Practice Address - Phone:512-626-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
TX63929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)