Provider Demographics
NPI:1770863607
Name:SYMONS, STACY COLEMAN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:COLEMAN
Last Name:SYMONS
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 FORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1917
Mailing Address - Country:US
Mailing Address - Phone:651-261-6983
Mailing Address - Fax:
Practice Address - Street 1:7582 CURRELL BLVD STE 108
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55125-8210
Practice Address - Country:US
Practice Address - Phone:651-261-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4460103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist