Provider Demographics
NPI:1932786613
Name:GARCELON, STACEY RENE (MED LMHCA, NCC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:RENE
Last Name:GARCELON
Suffix:
Gender:F
Credentials:MED LMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4298 E 1000 N
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8327
Mailing Address - Country:US
Mailing Address - Phone:219-448-8109
Mailing Address - Fax:
Practice Address - Street 1:4298 E 1000 N
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-8327
Practice Address - Country:US
Practice Address - Phone:219-448-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001186A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health