Provider Demographics
NPI:1194939108
Name:ZUGG, STACY (LCSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ZUGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:ZUGG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 5576
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5576
Mailing Address - Country:US
Mailing Address - Phone:432-570-0238
Mailing Address - Fax:432-699-3815
Practice Address - Street 1:2500 DELANO AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6357
Practice Address - Country:US
Practice Address - Phone:432-697-4747
Practice Address - Fax:432-699-3813
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical