Provider Demographics
NPI:1689114530
Name:WOOD, STACEY K (LMFT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:K
Last Name:WOOD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 RIO RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8670
Mailing Address - Country:US
Mailing Address - Phone:831-298-0019
Mailing Address - Fax:
Practice Address - Street 1:3771 RIO RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8670
Practice Address - Country:US
Practice Address - Phone:831-298-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist