Provider Demographics
NPI:1194941864
Name:STALCUP, IRENE (LCSW)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:STALCUP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-2115
Mailing Address - Country:US
Mailing Address - Phone:214-803-4787
Mailing Address - Fax:806-367-7972
Practice Address - Street 1:2605 PARKER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-2115
Practice Address - Country:US
Practice Address - Phone:214-803-4787
Practice Address - Fax:806-367-7972
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30383101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor