Provider Demographics
NPI:1689484339
Name:CANFIELD, STACY LANGE (MA, LPC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LANGE
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N EAST ST STE B
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3133
Mailing Address - Country:US
Mailing Address - Phone:254-346-5617
Mailing Address - Fax:
Practice Address - Street 1:204 N EAST ST STE B
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3133
Practice Address - Country:US
Practice Address - Phone:254-346-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health