Provider Demographics
NPI:1083959720
Name:FLATHERS, STACY SCHARLENE (PLPC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:SCHARLENE
Last Name:FLATHERS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3413
Mailing Address - Country:US
Mailing Address - Phone:660-537-4727
Mailing Address - Fax:
Practice Address - Street 1:409 E ASHLEY ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3413
Practice Address - Country:US
Practice Address - Phone:660-537-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012040539101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012040539OtherPLPC