Provider Demographics
NPI:1861601395
Name:COURTNEY, STACY LYNN (LPC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MONARCH CV
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2106
Mailing Address - Country:US
Mailing Address - Phone:512-626-4925
Mailing Address - Fax:512-410-4794
Practice Address - Street 1:303 MONARCH CV
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2106
Practice Address - Country:US
Practice Address - Phone:512-626-4925
Practice Address - Fax:512-410-4794
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026637101Medicaid