Provider Demographics
NPI:1477188860
Name:HOTH, STACEY (TLMHC, NCC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HOTH
Suffix:
Gender:F
Credentials:TLMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CRESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-4623
Mailing Address - Country:US
Mailing Address - Phone:319-215-0992
Mailing Address - Fax:
Practice Address - Street 1:110 CRESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-4623
Practice Address - Country:US
Practice Address - Phone:319-215-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health