Provider Demographics
NPI:1467799015
Name:TOWNSEND, STACIE ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:ANN
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:ANN
Other - Last Name:NOTTELMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15036 N 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4912
Mailing Address - Country:US
Mailing Address - Phone:602-931-6373
Mailing Address - Fax:480-794-1684
Practice Address - Street 1:15036 N 28TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4912
Practice Address - Country:US
Practice Address - Phone:602-931-6373
Practice Address - Fax:480-794-1684
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional