Provider Demographics
NPI:1104000769
Name:FYE, STACY (LPC/MHSP)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:FYE
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CUMBERLAND BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1805
Mailing Address - Country:US
Mailing Address - Phone:615-726-3340
Mailing Address - Fax:
Practice Address - Street 1:871 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5257
Practice Address - Country:US
Practice Address - Phone:866-816-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS1407101YP2500X
TN3299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1407OtherMISSISSIPPI STATE BOARD OF EXAMINERS FOR LICENSED PROFESSIONAL COUNSELORS
TN3299OtherTN BOARD OF PROF. COUNSELORS AND MARTIAL AND FAMILY THERAPISTS LICENSED PASTORAL
MSPH1444OtherMS DEPT OF MENTAL HEALTH