Provider Demographics
NPI:1760746200
Name:PULLEY, STACY M (LPC, MA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:PULLEY
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 VZ COUNTY ROAD 2512
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-3805
Mailing Address - Country:US
Mailing Address - Phone:903-312-4259
Mailing Address - Fax:
Practice Address - Street 1:121 S 5TH ST
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-2569
Practice Address - Country:US
Practice Address - Phone:903-312-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3185217Medicaid