Provider Demographics
NPI:1376379529
Name:MARLIN, STACY YVONNE (PMHNP--BC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:YVONNE
Last Name:MARLIN
Suffix:
Gender:F
Credentials:PMHNP--BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 GLEN CANYON DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-0920
Mailing Address - Country:US
Mailing Address - Phone:254-548-2617
Mailing Address - Fax:
Practice Address - Street 1:306 GLEN CANYON DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-0920
Practice Address - Country:US
Practice Address - Phone:254-548-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20240585832084P0800X
TX1179148363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2024058583OtherANCC
TX1179148OtherAPRN