Provider Demographics
NPI:1689813768
Name:ALLEN, STACI ALLEN (LMSW)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:ALLEN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:915 B YALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-6919
Mailing Address - Country:US
Mailing Address - Phone:713-868-0013
Mailing Address - Fax:
Practice Address - Street 1:11500 NORTHWEST FWY STE 465
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6538
Practice Address - Country:US
Practice Address - Phone:713-956-8194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37618104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker