Provider Demographics
NPI:1477651511
Name:ECORD, STACEY LYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:ECORD
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 1:3926 BAHLER AVE
Mailing Address - Street 2:
Mailing Address - City:MANUEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578
Mailing Address - Country:US
Mailing Address - Phone:281-489-1290
Mailing Address - Fax:281-489-8806
Practice Address - Street 1:3926 BAHLER AVE
Practice Address - Street 2:
Practice Address - City:MANUEL
Practice Address - State:TX
Practice Address - Zip Code:77578
Practice Address - Country:US
Practice Address - Phone:281-489-1290
Practice Address - Fax:281-489-8806
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional