Provider Demographics
NPI:1316680713
Name:STAGGS, NICCI LYNN (MS, MED, LPC)
Entity type:Individual
Prefix:
First Name:NICCI
Middle Name:LYNN
Last Name:STAGGS
Suffix:
Gender:F
Credentials:MS, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 NE GREEN OAKS BLVD APT 1301
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-7905
Mailing Address - Country:US
Mailing Address - Phone:972-821-2250
Mailing Address - Fax:
Practice Address - Street 1:1229 E PLEASANT RUN RD STE 305
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4229
Practice Address - Country:US
Practice Address - Phone:972-821-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional