Provider Demographics
NPI:1134304397
Name:RATH, STACY LYNN (PLMHP, MSW)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:LYNN
Last Name:RATH
Suffix:
Gender:F
Credentials:PLMHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16712 ERSKINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2645
Mailing Address - Country:US
Mailing Address - Phone:402-321-4698
Mailing Address - Fax:
Practice Address - Street 1:16712 ERSKINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2645
Practice Address - Country:US
Practice Address - Phone:402-321-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025215300Medicaid