Provider Demographics
NPI:1083959720
Name:FLATHERS, STACY SCHARLENE (LPC)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:SCHARLENE
Last Name:FLATHERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:SCHARLENE
Other - Last Name:YEAGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:140 CLIFF CAVE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3646
Mailing Address - Country:US
Mailing Address - Phone:618-343-5347
Mailing Address - Fax:
Practice Address - Street 1:140 CLIFF CAVE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3646
Practice Address - Country:US
Practice Address - Phone:618-343-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012040539101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012040539OtherPLPC