Provider Demographics
NPI:1538364435
Name:CONDON, STACIE A (MA, LPC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:A
Last Name:CONDON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27315 DOVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HUFFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:77336-3704
Mailing Address - Country:US
Mailing Address - Phone:281-324-3526
Mailing Address - Fax:
Practice Address - Street 1:19747 HIGHWAY 59 N
Practice Address - Street 2:SUITE 222
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3576
Practice Address - Country:US
Practice Address - Phone:832-527-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional