Provider Demographics
NPI:1508991290
Name:BRAUN, STACY (LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6857 MOUNTAIN TOP LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1951
Mailing Address - Country:US
Mailing Address - Phone:719-599-0921
Mailing Address - Fax:
Practice Address - Street 1:2502 W COLORADO AVE
Practice Address - Street 2:#207
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3023
Practice Address - Country:US
Practice Address - Phone:719-331-8636
Practice Address - Fax:719-471-9987
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional