Provider Demographics
NPI:1063064111
Name:BRITTAIN, STACY ANNETTE (LMFT)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANNETTE
Last Name:BRITTAIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14359 E PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-9063
Mailing Address - Country:US
Mailing Address - Phone:650-793-4966
Mailing Address - Fax:
Practice Address - Street 1:610 W HUBBARD ST STE 226
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2200
Practice Address - Country:US
Practice Address - Phone:650-793-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist