Provider Demographics
NPI:1477096725
Name:SLOCUM, STACY LOVELL I (APCC)
Entity Type:Individual
Prefix:MR
First Name:STACY
Middle Name:LOVELL
Last Name:SLOCUM
Suffix:I
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 E ROCKINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5340
Mailing Address - Country:US
Mailing Address - Phone:559-573-4863
Mailing Address - Fax:
Practice Address - Street 1:1027 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3429
Practice Address - Country:US
Practice Address - Phone:559-268-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34689167G00000X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician