Provider Demographics
NPI:1699181461
Name:TRIPLETT, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 AIRPORT INTERCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-1002
Mailing Address - Country:US
Mailing Address - Phone:901-332-2227
Mailing Address - Fax:901-332-0477
Practice Address - Street 1:2305 AIRPORT INTERCHANGE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-1002
Practice Address - Country:US
Practice Address - Phone:901-332-2227
Practice Address - Fax:901-332-0477
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)