Provider Demographics
NPI:1518931914
Name:MEEHL, STACEY (MS)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MEEHL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S MAIN ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4172
Mailing Address - Country:US
Mailing Address - Phone:605-225-1010
Mailing Address - Fax:605-725-8055
Practice Address - Street 1:14 S MAIN ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4172
Practice Address - Country:US
Practice Address - Phone:605-225-1010
Practice Address - Fax:605-725-8055
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND491-7-01-03-152101Y00000X
SDLPCMH2112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575973Medicaid