Provider Demographics
NPI:1831611078
Name:DELBAUGH, STACY ELLEN (MS, CAC III)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ELLEN
Last Name:DELBAUGH
Suffix:
Gender:F
Credentials:MS, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 E DRY CREEK RD STE B201
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2560
Mailing Address - Country:US
Mailing Address - Phone:720-837-0908
Mailing Address - Fax:
Practice Address - Street 1:7200 E DRY CREEK RD STE B201
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2560
Practice Address - Country:US
Practice Address - Phone:720-837-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6128101YA0400X
CO00000928101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000189339Medicaid