Provider Demographics
NPI:1487842167
Name:MARTIN, STACY J (LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:J
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:15512 MISS ADRIENNES PATH
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3282
Mailing Address - Country:US
Mailing Address - Phone:512-659-8614
Mailing Address - Fax:
Practice Address - Street 1:15512 MISS ADRIENNES PATH
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3282
Practice Address - Country:US
Practice Address - Phone:512-659-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17595101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor