Provider Demographics
NPI:1487180048
Name:ROWLETT, STACY (MAC, LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ROWLETT
Suffix:
Gender:F
Credentials:MAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 YELLOW JASMINE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3192
Mailing Address - Country:US
Mailing Address - Phone:314-517-0247
Mailing Address - Fax:
Practice Address - Street 1:3548 YELLOW JASMINE DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3192
Practice Address - Country:US
Practice Address - Phone:314-517-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015012004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional