Provider Demographics
NPI:1124731773
Name:EXCEUS, STACI JOANNA
Entity type:Individual
Prefix:MRS
First Name:STACI
Middle Name:JOANNA
Last Name:EXCEUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 DREAMY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1761
Mailing Address - Country:US
Mailing Address - Phone:407-233-7634
Mailing Address - Fax:
Practice Address - Street 1:1456 DREAMY WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1761
Practice Address - Country:US
Practice Address - Phone:407-233-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY5469459OtherCALIFORNIA DMV