Provider Demographics
NPI:1356450266
Name:KREITZ, STACEY MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARIE
Last Name:KREITZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:GROTEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:79 E MAIN ST STE 303
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1941
Mailing Address - Country:US
Mailing Address - Phone:805-295-0458
Mailing Address - Fax:
Practice Address - Street 1:79 E MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1941
Practice Address - Country:US
Practice Address - Phone:805-295-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001336106H00000X
CA49183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist