Provider Demographics
NPI:1700521069
Name:TEAGUE, STACY MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MARIE
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 BALLEYBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7634
Mailing Address - Country:US
Mailing Address - Phone:940-448-0226
Mailing Address - Fax:
Practice Address - Street 1:2315 BALLEYBROOKE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-7634
Practice Address - Country:US
Practice Address - Phone:940-448-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical