Provider Demographics
NPI:1336285576
Name:PALICKI, STACY L (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:PALICKI
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351296
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-1296
Mailing Address - Country:US
Mailing Address - Phone:419-842-0860
Mailing Address - Fax:419-842-0861
Practice Address - Street 1:2758 N. CENTENNIAL RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1135
Practice Address - Country:US
Practice Address - Phone:419-842-0860
Practice Address - Fax:419-842-0861
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health