Provider Demographics
NPI:1093858722
Name:MCCUNE, STACY L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:L
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:MINIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:209 N MAYSVILLE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1179
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-498-8160
Practice Address - Street 1:209 N MAYSVILLE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1179
Practice Address - Country:US
Practice Address - Phone:859-404-7686
Practice Address - Fax:859-498-8160
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100265570Medicaid