Provider Demographics
NPI:1689214355
Name:STANLEY, STACY LYNN (CPC-I)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:CPC-I
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:HUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1640 ALTA DR STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4165
Mailing Address - Country:US
Mailing Address - Phone:702-474-6450
Mailing Address - Fax:702-474-6463
Practice Address - Street 1:1640 ALTA DR STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4165
Practice Address - Country:US
Practice Address - Phone:702-474-6450
Practice Address - Fax:702-474-6463
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)