Provider Demographics
NPI:1376885681
Name:TRAVERS, STACY ELIZABETH (MS, MFT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ELIZABETH
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 S RAINBOW BLVD # 276
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6477
Mailing Address - Country:US
Mailing Address - Phone:702-686-8807
Mailing Address - Fax:702-640-0413
Practice Address - Street 1:8879 W FLAMINGO RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8732
Practice Address - Country:US
Practice Address - Phone:702-610-1160
Practice Address - Fax:702-362-0200
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist