Provider Demographics
NPI:1174679559
Name:PIERCE, STACEY FUSELIER (LPC, LMFT, NCC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:FUSELIER
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4839 DIXIE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4023
Mailing Address - Country:US
Mailing Address - Phone:318-286-7454
Mailing Address - Fax:318-286-7454
Practice Address - Street 1:401 HAMILTON RD STE 114
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4615
Practice Address - Country:US
Practice Address - Phone:318-286-7454
Practice Address - Fax:318-286-7454
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
LA2387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty