Provider Demographics
NPI:1407460702
Name:MARSHALL, STACY (LPC-I)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 FRANCISCAN DR APT 1336
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2565
Mailing Address - Country:US
Mailing Address - Phone:817-773-7908
Mailing Address - Fax:
Practice Address - Street 1:509 N WINNETKA AVE STE 207
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5170
Practice Address - Country:US
Practice Address - Phone:972-755-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional