Provider Demographics
NPI:1205606852
Name:STAHLER, MADDISON MCKENZIE
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:MCKENZIE
Last Name:STAHLER
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 1:102 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2949
Mailing Address - Country:US
Mailing Address - Phone:972-292-0007
Mailing Address - Fax:
Practice Address - Street 1:102 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2949
Practice Address - Country:US
Practice Address - Phone:972-292-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health