Provider Demographics
NPI:1033510482
Name:LING, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 BIG BEAR AVE
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7754
Mailing Address - Country:US
Mailing Address - Phone:740-657-4800
Mailing Address - Fax:740-657-4849
Practice Address - Street 1:8715 BIG BEAR AVE
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7754
Practice Address - Country:US
Practice Address - Phone:740-657-4800
Practice Address - Fax:740-657-4849
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3129732103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool