Provider Demographics
NPI:1366908188
Name:STAGAR, MICHAEL STEPHEN IV (LPC, LCDC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:STAGAR
Suffix:IV
Gender:M
Credentials:LPC, LCDC
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:STEPHEN
Other - Last Name:STAGAR
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCDC
Mailing Address - Street 1:2201 CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4110
Mailing Address - Country:US
Mailing Address - Phone:254-519-8803
Mailing Address - Fax:
Practice Address - Street 1:2407 CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5721
Practice Address - Country:US
Practice Address - Phone:254-519-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13965101YA0400X
TX76862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)