# MR. CHARLES BENSON STACEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1699985259
- **Gender:** Man
- **Credential:** LMFT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | 4426 | TX | — |
| 106H00000X | Marriage & Family Therapist | CMF0068702 | NM | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 02/29/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 84254289 | — | NM |