Individual
MR. CHARLES BENSON STACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
3510 MESSINA DR, FARMINGTON, NM 87402-4782
(832) 630-3022
Mailing address
3510 MESSINA DR, FARMINGTON, NM 87402-4782
(832) 630-3022
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
4426
TX
106H00000X
Marriage & Family Therapist
Primary
CMF0068702
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84254289
—
NM
Enumeration date
05/23/2007
Last updated
02/29/2020
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