Provider Demographics
NPI:1104000769
Name:HAAG, STACY (LPC/MHSP)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:HAAG
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:FYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 OTIS SMITH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8940
Mailing Address - Country:US
Mailing Address - Phone:931-320-9213
Mailing Address - Fax:
Practice Address - Street 1:105 OTIS SMITH DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8940
Practice Address - Country:US
Practice Address - Phone:931-320-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS1407101YP2500X
TN3299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1407OtherMISSISSIPPI STATE BOARD OF EXAMINERS FOR LICENSED PROFESSIONAL COUNSELORS
MSPH1444OtherMS DEPT OF MENTAL HEALTH
TN3299OtherTN BOARD OF PROF. COUNSELORS AND MARTIAL AND FAMILY THERAPISTS LICENSED PASTORAL
KY290113OtherKENTUCKY STATE BOARD OF PROF. COUNSELORS