Provider Demographics
NPI:1669853107
Name:MACEK, STACY (MA, AT, LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MACEK
Suffix:
Gender:F
Credentials:MA, AT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28700 EUCLID AVE
Mailing Address - Street 2:ISSENMANN BUILDING
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2527
Mailing Address - Country:US
Mailing Address - Phone:440-943-7607
Mailing Address - Fax:
Practice Address - Street 1:28700 EUCLID AVE
Practice Address - Street 2:ISSENMANN BUILDING
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2527
Practice Address - Country:US
Practice Address - Phone:440-943-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000584101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health