Provider Demographics
NPI:1528378148
Name:STIFFEY, DARRELL C JR
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:C
Last Name:STIFFEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 RATHERVUE PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3127
Mailing Address - Country:US
Mailing Address - Phone:210-365-7204
Mailing Address - Fax:
Practice Address - Street 1:607 RATHERVUE PL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3127
Practice Address - Country:US
Practice Address - Phone:210-365-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-16
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical