Basic Information
| Provider Information | |||||||||
| NPI: | 1801953732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYS | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | DIAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1970 RAWHIDE DR | ||||||||
| Address2: | SUITE #206 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786816957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123883638 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1970 RAWHIDE DR | ||||||||
| Address2: | SUITE #206 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786816957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123883638 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 61263 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.