Provider Demographics
NPI:1356989099
Name:PINEDA, STACY (LAMFT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:PINEDA
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W USTICK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6133
Mailing Address - Country:US
Mailing Address - Phone:208-366-1678
Mailing Address - Fax:
Practice Address - Street 1:750 W USTICK RD STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6133
Practice Address - Country:US
Practice Address - Phone:208-366-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
IDLAMFT-8410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist