Provider Demographics
NPI:1639471345
Name:STACY, ALAN WAYNE (MA)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:WAYNE
Last Name:STACY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:AL
Other - Middle Name:
Other - Last Name:STACY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11185 NEW CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:BON AQUA
Mailing Address - State:TN
Mailing Address - Zip Code:37025-3148
Mailing Address - Country:US
Mailing Address - Phone:615-752-0710
Mailing Address - Fax:
Practice Address - Street 1:633 THOMPSON LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3616
Practice Address - Country:US
Practice Address - Phone:615-463-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health