Provider Demographics
NPI:1063710556
Name:MAIER, STACY JO (LCSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JO
Last Name:MAIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:JO
Other - Last Name:MAIER MCGLYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4115 SAXONY PL
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5252
Mailing Address - Country:US
Mailing Address - Phone:406-671-4797
Mailing Address - Fax:
Practice Address - Street 1:4115 SAXONY PL
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5252
Practice Address - Country:US
Practice Address - Phone:406-671-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical