Provider Demographics
NPI:1659777621
Name:SPHAR, STACY ELIZABETH (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ELIZABETH
Last Name:SPHAR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-3457
Mailing Address - Country:US
Mailing Address - Phone:530-233-6312
Mailing Address - Fax:530-233-6339
Practice Address - Street 1:441 N. MAIN ST
Practice Address - Street 2:MODOC COUNTY BEHAVIORAL HEALTH
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3457
Practice Address - Country:US
Practice Address - Phone:530-233-6312
Practice Address - Fax:530-233-6339
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA753317163W00000X
CA95017532363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse