| Doctor Name: | MS. STACEY L. CUNNINGHAM |
| NPI Number: | 1013116607 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 19686 |
| Business Practice Address: | 1011 Alley A St Bastrop, TX - 786023240 |
| Business Phone Number: | 5125818435 |
| Business Fax Number: | 5123322025 |
| Mailing Address: | 1011 Alley A, BASTROP |
| State: | TX |
| Postal Code: | 786023240 |
| Phone Number: | 5125818435 |
| Fax Number: | 5123322025 |
| NPI Enumeration Date: | 07/13/2007 |
| NPI Last Update Date: | 07/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 19686 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |