Provider Demographics
NPI:1972637700
Name:IKARD, STACY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:IKARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MADISON ST SE
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4419
Mailing Address - Country:US
Mailing Address - Phone:256-519-9000
Mailing Address - Fax:256-519-9002
Practice Address - Street 1:805 MADISON ST SE
Practice Address - Street 2:SUITE 2-C
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4419
Practice Address - Country:US
Practice Address - Phone:256-519-9000
Practice Address - Fax:256-519-9002
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51519560OtherBCBS OF AL
51521363OtherAMERICAN BEHAVIORAL
11608140OtherCAQH