Provider Demographics
NPI:1659091742
Name:GARCIA, STACIE DIANE (LPC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:DIANE
Last Name:GARCIA
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 1:590 COUNTY ROAD 3701
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-8106
Mailing Address - Country:US
Mailing Address - Phone:903-227-0542
Mailing Address - Fax:
Practice Address - Street 1:590 COUNTY ROAD 3701
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-8106
Practice Address - Country:US
Practice Address - Phone:903-227-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89865101YM0800X, 101YP2500X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty