Provider Demographics
NPI:1316018807
Name:ADAIR, STACEY ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ELLEN
Last Name:ADAIR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LONG BEACH BLVD
Mailing Address - Street 2:230
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2007
Mailing Address - Country:US
Mailing Address - Phone:562-988-1000
Mailing Address - Fax:562-426-5211
Practice Address - Street 1:4201 LONG BEACH BLVD
Practice Address - Street 2:230
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2007
Practice Address - Country:US
Practice Address - Phone:562-988-1000
Practice Address - Fax:562-426-5211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20048103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY200480Medicaid