Provider Demographics
NPI:1982349734
Name:STAGGS, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:STAGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:LILLIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76061-0225
Mailing Address - Country:US
Mailing Address - Phone:682-498-3011
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 225
Practice Address - Street 2:
Practice Address - City:LILLIAN
Practice Address - State:TX
Practice Address - Zip Code:76061-0225
Practice Address - Country:US
Practice Address - Phone:682-498-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100178101YM0800X, 101YP2500X, 101YA0400X
LA9008101YP2500X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)