Provider Demographics
NPI:1922791722
Name:MARSH, STACY J (AMFT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:J
Last Name:MARSH
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 1:12 VIA DIEGO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7042
Mailing Address - Country:US
Mailing Address - Phone:949-355-3066
Mailing Address - Fax:
Practice Address - Street 1:13 CORPORATE PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7964
Practice Address - Country:US
Practice Address - Phone:858-735-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health