Provider Demographics
NPI:1497908602
Name:DAVIS, STACY TEMPLETON (PSYD, MP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:TEMPLETON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W PINHOOK RD STE 504
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3212
Mailing Address - Country:US
Mailing Address - Phone:630-747-3898
Mailing Address - Fax:
Practice Address - Street 1:2020 W PINHOOK RD STE 504
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3212
Practice Address - Country:US
Practice Address - Phone:337-593-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1073103TC0700X, 103TC2200X
LA339669103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3A987C689Medicare PIN
LA3A987Medicare PIN