Provider Demographics
NPI:1124733589
Name:STILES, DONALD LOUIS (LMSW)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LOUIS
Last Name:STILES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17143 COUNTY ROAD 541
Mailing Address - Street 2:
Mailing Address - City:LAVON
Mailing Address - State:TX
Mailing Address - Zip Code:75166-1422
Mailing Address - Country:US
Mailing Address - Phone:469-983-1300
Mailing Address - Fax:
Practice Address - Street 1:1420 W MOCKINGBIRD LN STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4936
Practice Address - Country:US
Practice Address - Phone:469-983-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108467104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108467OtherTEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS