Provider Demographics
NPI:1790970820
Name:TAYLOR, STACEY L (MED, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 FIR DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9605
Mailing Address - Country:US
Mailing Address - Phone:610-554-6389
Mailing Address - Fax:
Practice Address - Street 1:1005 BROOKSIDE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9023
Practice Address - Country:US
Practice Address - Phone:610-554-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional