Provider Demographics
NPI:1356623979
Name:FARROW, STACE DEVILLIER (LPC)
Entity type:Individual
Prefix:MRS
First Name:STACE
Middle Name:DEVILLIER
Last Name:FARROW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 S STATE HIGHWAY 16
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-9408
Mailing Address - Country:US
Mailing Address - Phone:830-990-7999
Mailing Address - Fax:830-990-7999
Practice Address - Street 1:945 E ASHWOOD LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-1412
Practice Address - Country:US
Practice Address - Phone:830-343-7025
Practice Address - Fax:830-990-7999
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional