Provider Demographics
NPI:1265964837
Name:GORAN, STACIE KAMILLE (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:KAMILLE
Last Name:GORAN
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 HILTON HEAD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-0830
Mailing Address - Country:US
Mailing Address - Phone:432-212-1490
Mailing Address - Fax:
Practice Address - Street 1:5804 HILTON HEAD DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-0830
Practice Address - Country:US
Practice Address - Phone:432-212-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70397101Y00000X
TX11925101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)