Provider Demographics
NPI:1447384904
Name:ELLIOTT, STACY V (MFT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:V
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MFT
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 1512
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-1512
Mailing Address - Country:US
Mailing Address - Phone:510-388-0090
Mailing Address - Fax:
Practice Address - Street 1:1333A VINEYARD TERRACE CT
Practice Address - Street 2:
Practice Address - City:MURPHYS
Practice Address - State:CA
Practice Address - Zip Code:95247-1512
Practice Address - Country:US
Practice Address - Phone:510-388-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51666106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist