Provider Demographics
NPI:1063005247
Name:DELANEY, STACI RENE' (LPC)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:RENE'
Last Name:DELANEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:R
Other - Last Name:TRAMMELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2252 KINGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4838
Mailing Address - Country:US
Mailing Address - Phone:928-303-0269
Mailing Address - Fax:
Practice Address - Street 1:2252 KINGMAN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4838
Practice Address - Country:US
Practice Address - Phone:928-303-0269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional