Provider Demographics
NPI:1700152121
Name:MESIAS, STACY (MS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MESIAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 E VERMIJO AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3791
Mailing Address - Country:US
Mailing Address - Phone:719-232-0176
Mailing Address - Fax:
Practice Address - Street 1:422 E VERMIJO AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3791
Practice Address - Country:US
Practice Address - Phone:719-232-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health