Provider Demographics
NPI:1568010080
Name:BROWN, STACIE L (LPC, CCTP)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 STACEY DR
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-6497
Mailing Address - Country:US
Mailing Address - Phone:602-663-1491
Mailing Address - Fax:
Practice Address - Street 1:2820 N LYNX LAKE DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2541
Practice Address - Country:US
Practice Address - Phone:602-663-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional