Provider Demographics
NPI:1154507044
Name:STANLEY, STAN E (LPC)
Entity type:Individual
Prefix:
First Name:STAN
Middle Name:E
Last Name:STANLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 WING RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1624
Mailing Address - Country:US
Mailing Address - Phone:512-964-7301
Mailing Address - Fax:512-382-1966
Practice Address - Street 1:4902 WING RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1624
Practice Address - Country:US
Practice Address - Phone:512-964-7301
Practice Address - Fax:512-382-1966
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional