Provider Demographics
NPI:1720275738
Name:STAHL, STACEY (LCSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:ESSENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10833 DONNER PASS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4851
Mailing Address - Country:US
Mailing Address - Phone:530-414-8014
Mailing Address - Fax:844-361-3018
Practice Address - Street 1:10833 DONNER PASS RD STE 206
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4851
Practice Address - Country:US
Practice Address - Phone:530-414-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5736-C1041C0700X
CA266361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26636OtherBOARD OF BEHAVIORAL SCIENCES, CA
NV5736-COtherBOARD OF SOCIAL WORK EXAMINERS