Provider Demographics
NPI:1447566294
Name:LARSEN, STACEY N (LMFT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:N
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:N
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5385 HOLLISTER AVE BLDG 14
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2389
Mailing Address - Country:US
Mailing Address - Phone:805-884-1679
Mailing Address - Fax:
Practice Address - Street 1:110 S C ST STE A
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7340
Practice Address - Country:US
Practice Address - Phone:805-735-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist