Provider Demographics
NPI:1134981988
Name:JULIAN FRALISH, STACEY L (LSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:JULIAN FRALISH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 TOMAH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6968
Mailing Address - Country:US
Mailing Address - Phone:719-999-5073
Mailing Address - Fax:
Practice Address - Street 1:5376 TOMAH DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6968
Practice Address - Country:US
Practice Address - Phone:719-999-5073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009922727104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker