Provider Demographics
NPI:1811429616
Name:MASSENGILL-MUNRO, STACY D (LPCC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:D
Last Name:MASSENGILL-MUNRO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W SAYERS DR
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-3714
Mailing Address - Country:US
Mailing Address - Phone:575-318-8269
Mailing Address - Fax:
Practice Address - Street 1:215 W BROADWAY ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-6065
Practice Address - Country:US
Practice Address - Phone:575-393-0692
Practice Address - Fax:575-393-0796
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0126711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health