Provider Demographics
NPI:1770095259
Name:ARNETT, STACEY ANN (PHD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:ARNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 ARAPAHOE AVE APT 702
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6184
Mailing Address - Country:US
Mailing Address - Phone:303-921-2475
Mailing Address - Fax:
Practice Address - Street 1:1050 ARAPAHOE AVE APT 702
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6184
Practice Address - Country:US
Practice Address - Phone:303-921-2475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0004513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health