Provider Demographics
NPI:1982357190
Name:GRUHN, STACY REBEKAH (MS, NCC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:REBEKAH
Last Name:GRUHN
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:REBEKAH
Other - Last Name:BURNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 SPRING BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4807
Mailing Address - Country:US
Mailing Address - Phone:706-593-2584
Mailing Address - Fax:
Practice Address - Street 1:408 N CEDAR BLUFF RD STE 305
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3648
Practice Address - Country:US
Practice Address - Phone:865-888-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health