Provider Demographics
NPI:1124565791
Name:STACY, BRETRESE (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:BRETRESE
Middle Name:
Last Name:STACY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 STREET LANE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35555
Mailing Address - Country:US
Mailing Address - Phone:205-317-5957
Mailing Address - Fax:
Practice Address - Street 1:13 OFFICE PARK CIR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2556
Practice Address - Country:US
Practice Address - Phone:205-317-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health