Provider Demographics
NPI:1558464602
Name:STANLEY, VELMA JEAN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:VELMA
Middle Name:JEAN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WILDLIFE LN
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-1615
Mailing Address - Country:US
Mailing Address - Phone:936-238-3868
Mailing Address - Fax:
Practice Address - Street 1:103 WILDLIFE LN
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-1615
Practice Address - Country:US
Practice Address - Phone:936-238-3868
Practice Address - Fax:936-238-3867
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18536101YM0800X
TX38601103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162728303Medicaid