Provider Demographics
NPI:1689678302
Name:HARLAN, STANLEY RAY (MDIV, MED)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:RAY
Last Name:HARLAN
Suffix:
Gender:M
Credentials:MDIV, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 MILL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6732
Mailing Address - Country:US
Mailing Address - Phone:512-665-2083
Mailing Address - Fax:512-396-5680
Practice Address - Street 1:101 UHLAND RD
Practice Address - Street 2:STE 202
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6681
Practice Address - Country:US
Practice Address - Phone:512-396-8540
Practice Address - Fax:512-396-5680
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003277106H00000X
TX10684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025985501Medicaid