Provider Demographics
NPI:1467590869
Name:SOLSAA, STACY MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:SOLSAA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MARIE
Other - Last Name:MALSAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 JENSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-5259
Mailing Address - Country:US
Mailing Address - Phone:605-880-0100
Mailing Address - Fax:605-882-4323
Practice Address - Street 1:1105 JENSON AVE SE STE 7
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-5259
Practice Address - Country:US
Practice Address - Phone:605-880-0100
Practice Address - Fax:866-635-3236
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health