Provider Demographics
NPI:1912791542
Name:STULSAS, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STULSAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 WELCOME
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8170
Mailing Address - Country:US
Mailing Address - Phone:210-544-3383
Mailing Address - Fax:
Practice Address - Street 1:6930 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3715
Practice Address - Country:US
Practice Address - Phone:979-325-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-3858-709206106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician