Provider Demographics
NPI:1730219965
Name:NAKELL, STACY KIM (LCSW)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:KIM
Last Name:NAKELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 BAYLOR ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4104
Mailing Address - Country:US
Mailing Address - Phone:512-586-6862
Mailing Address - Fax:
Practice Address - Street 1:1211 BAYLOR ST
Practice Address - Street 2:STE. 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4104
Practice Address - Country:US
Practice Address - Phone:512-586-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87670QOtherBCBS