Doctor Name: | MS. STACY ALBERT JERRETT |
NPI Number: | 1154597326 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 19592 |
Business Practice Address: | 12100 Fm 3025 Stephenville, TX - 764016402 |
Business Phone Number: | 2549653623 |
Business Fax Number: | 8175942509 |
Mailing Address: | 12100 Fm 3025, STEPHENVILLE |
State: | TX |
Postal Code: | 764016402 |
Phone Number: | 2549653623 |
Fax Number: | 8175942509 |
NPI Enumeration Date: | 05/07/2008 |
NPI Last Update Date: | 05/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 19592 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |