Provider Demographics
NPI:1396386108
Name:SWATZEL, STACEY JO (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:JO
Last Name:SWATZEL
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LIBBY CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-8614
Mailing Address - Country:US
Mailing Address - Phone:936-442-1001
Mailing Address - Fax:
Practice Address - Street 1:121 LIBBY CIR
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8614
Practice Address - Country:US
Practice Address - Phone:936-442-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3068103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst