Provider Demographics
NPI:1841454519
Name:STACK, SHELIA K (PHD)
Entity type:Individual
Prefix:MS
First Name:SHELIA
Middle Name:K
Last Name:STACK
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 1:349 WESTERN DR APT H
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3043
Mailing Address - Country:US
Mailing Address - Phone:831-425-5819
Mailing Address - Fax:
Practice Address - Street 1:349 WESTERN DR APT H
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3043
Practice Address - Country:US
Practice Address - Phone:831-425-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical