Provider Demographics
NPI:1114011855
Name:CARD, STACY L (LMHC, LCPC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:CARD
Suffix:
Gender:
Credentials:LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 N PARKSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2341
Mailing Address - Country:US
Mailing Address - Phone:509-995-4249
Mailing Address - Fax:
Practice Address - Street 1:1565 E LEIGH FIELD DR STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6950
Practice Address - Country:US
Practice Address - Phone:509-534-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID10260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health