Provider Demographics
NPI:1841343555
Name:REID, STACY A (MFT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:A
Last Name:REID
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 PHOENIX LN
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6924
Mailing Address - Country:US
Mailing Address - Phone:510-459-7072
Mailing Address - Fax:443-458-7072
Practice Address - Street 1:3185 PHOENIX LN
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6924
Practice Address - Country:US
Practice Address - Phone:510-459-7072
Practice Address - Fax:443-458-7072
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist