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Individual
STACY A SHOCK
Active
Individual
STACY A SHOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
79482
TX
101YP2500X
Professional Counselor
79482
TX
Other
Enumeration date
10/19/2020
Last updated
04/01/2024
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