Provider Demographics
NPI:1851170039
Name:ULRY, STACEY K (LPC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:K
Last Name:ULRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHISHOLM TRAIL RD STE 450
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5094
Mailing Address - Country:US
Mailing Address - Phone:512-546-6798
Mailing Address - Fax:512-591-0049
Practice Address - Street 1:1311 CHISHOLM TRAIL RD STE 201
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2969
Practice Address - Country:US
Practice Address - Phone:512-546-6798
Practice Address - Fax:512-591-0049
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91990101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health