Provider Demographics
NPI:1881852119
Name:HAUCK, STACEY LYNN (LPC-MH, QMHP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:HAUCK
Suffix:
Gender:F
Credentials:LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 69TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8322
Mailing Address - Country:US
Mailing Address - Phone:605-271-9890
Mailing Address - Fax:605-799-8174
Practice Address - Street 1:1601 E 69TH ST STE 202
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8322
Practice Address - Country:US
Practice Address - Phone:605-271-9890
Practice Address - Fax:605-799-8174
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SDLPC-MH2186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health