Provider Demographics
NPI:1699426288
Name:EGGLESTON, STUART DANE (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:DANE
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 SLIDE RD STE 24
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2828
Mailing Address - Country:US
Mailing Address - Phone:806-370-0836
Mailing Address - Fax:
Practice Address - Street 1:8008 SLIDE RD STE 24
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2828
Practice Address - Country:US
Practice Address - Phone:806-370-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health