Provider Demographics
NPI:1487713715
Name:STACKS, FELICIA (LPC)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:STACKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AIRPORT RD
Mailing Address - Street 2:PO BOX 747
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-4302
Mailing Address - Country:US
Mailing Address - Phone:972-524-4159
Mailing Address - Fax:972-563-5321
Practice Address - Street 1:1300 W. 16TH ST.
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455
Practice Address - Country:US
Practice Address - Phone:903-572-8783
Practice Address - Fax:903-572-6965
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84078LOtherPRIVATE INSURANCE ID