Provider Demographics
NPI:1689970709
Name:BAUGHMAN, STACEY (MAPC, LPC, CSAT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:MAPC, LPC, CSAT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18789 N REEMS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8648
Mailing Address - Country:US
Mailing Address - Phone:623-910-3371
Mailing Address - Fax:
Practice Address - Street 1:18789 N REEMS RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8648
Practice Address - Country:US
Practice Address - Phone:623-910-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional