Provider Demographics
NPI:1962676908
Name:BROWN, STACY ELLEN (MC)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ELLEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ELLEN
Other - Last Name:MCINTIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC
Mailing Address - Street 1:8931 HURON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6806
Mailing Address - Country:US
Mailing Address - Phone:303-853-3500
Mailing Address - Fax:
Practice Address - Street 1:8931 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6806
Practice Address - Country:US
Practice Address - Phone:303-853-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025332900Medicaid
NE470823035Medicaid
NE470823035Medicaid