Provider Demographics
NPI:1669596904
Name:HARDESTY, STACEY RENEE (MA, LPC, BC-DMT, AC)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:RENEE
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:MA, LPC, BC-DMT, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 EMPIRE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2677
Mailing Address - Country:US
Mailing Address - Phone:303-818-9659
Mailing Address - Fax:720-890-7247
Practice Address - Street 1:380 EMPIRE RD
Practice Address - Street 2:STE 220
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2677
Practice Address - Country:US
Practice Address - Phone:303-818-9659
Practice Address - Fax:720-890-7247
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health