Provider Demographics
NPI:1427563170
Name:FELCH, STACY M
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:FELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHADBOURNE RD STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9644
Mailing Address - Country:US
Mailing Address - Phone:707-439-4039
Mailing Address - Fax:
Practice Address - Street 1:500 CHADBOURNE RD STE B
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9644
Practice Address - Country:US
Practice Address - Phone:707-439-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist