Provider Demographics
NPI:1295223790
Name:JONES, STACY EZELL (LCSW, LCADC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:EZELL
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-2416
Mailing Address - Country:US
Mailing Address - Phone:270-350-2776
Mailing Address - Fax:
Practice Address - Street 1:517 N ELM ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2416
Practice Address - Country:US
Practice Address - Phone:270-350-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical