Provider Demographics
NPI:1760620595
Name:MCLAUGHLIN, STACEY JOHNSON (PY 7039)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:JOHNSON
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:PY 7039
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 S FLORIDA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2183
Mailing Address - Country:US
Mailing Address - Phone:863-709-8110
Mailing Address - Fax:863-709-8118
Practice Address - Street 1:4404 S FLORIDA AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2183
Practice Address - Country:US
Practice Address - Phone:863-709-8110
Practice Address - Fax:863-709-8118
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6743103TC1900X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool