Provider Demographics
NPI:1538113402
Name:STANLEY, TIMOTHY D (MSLPE)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MSLPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3527
Mailing Address - Country:US
Mailing Address - Phone:903-243-9552
Mailing Address - Fax:
Practice Address - Street 1:1109 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3527
Practice Address - Country:US
Practice Address - Phone:903-243-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14579101YM0800X
AR961E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health