Provider Demographics
NPI:1861539306
Name:MOYLER, STACEY DIONE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:DIONE
Last Name:MOYLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:DIONE
Other - Last Name:BURKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW,MBA
Mailing Address - Street 1:2002 HOLCOMBE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4211
Mailing Address - Country:US
Mailing Address - Phone:463-234-2096
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:346-234-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085828104100000X
TX61882104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker