Provider Demographics
NPI:1124552625
Name:NEVILLS, STACEY P
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:P
Last Name:NEVILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0374
Mailing Address - Country:US
Mailing Address - Phone:337-418-7319
Mailing Address - Fax:
Practice Address - Street 1:1209 DIESI ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-7823
Practice Address - Country:US
Practice Address - Phone:337-418-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health