Provider Demographics
NPI:1851969018
Name:SCATES, STACY (AMFT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SCATES
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 N ALVARADO ST UNIT 26564
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-7432
Mailing Address - Country:US
Mailing Address - Phone:323-813-6103
Mailing Address - Fax:
Practice Address - Street 1:12240 VENICE BLVD STE 15A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3891
Practice Address - Country:US
Practice Address - Phone:323-813-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling