Provider Demographics
NPI:1518663012
Name:HARRISON, STACY BOONE (LPCC, RN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:BOONE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPCC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3326
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80307-3326
Mailing Address - Country:US
Mailing Address - Phone:720-633-5799
Mailing Address - Fax:
Practice Address - Street 1:636 COFFMAN ST STE 203
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4974
Practice Address - Country:US
Practice Address - Phone:303-335-0215
Practice Address - Fax:303-568-6727
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0018031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional