Provider Demographics
NPI:1114097631
Name:NATION, STACY GAYLE YORK (LCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:GAYLE YORK
Last Name:NATION
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 4TH STREET
Mailing Address - Street 2:PO BOX 591
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-0591
Mailing Address - Country:US
Mailing Address - Phone:720-295-4015
Mailing Address - Fax:888-377-6720
Practice Address - Street 1:149 4TH STREET
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446-0591
Practice Address - Country:US
Practice Address - Phone:720-295-4015
Practice Address - Fax:888-377-6720
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15091041C0700X
CO20731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0503932Medicaid
MT000071535OtherBCBS