Provider Demographics
NPI:1740677798
Name:LOYD, STACIE RENEE
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:RENEE
Last Name:LOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BASICS NW, LLC
Mailing Address - Street 2:8282 28TH CT NE STE A
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BASICS NW, LLC
Practice Address - Street 2:8282 28TH CT NE STE A
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516
Practice Address - Country:US
Practice Address - Phone:360-915-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB6856491171M00000X
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator